Medicaid Fraud and Patient Abuse

Examples of Medicaid fraud include:

  • Billing for medical services not actually performed.
    • Examples:
      • Home health care visits that don't take place
      • Durable medical supplies that aren't delivered
      • Lab testing that wasn't ordered or performed
      • Dentist billings for treatments not rendered or fillings not completed.
      • Failing to provide adequate, necessary care recipients under the RiteCare Program (underutilization).
  • Billing for a more expensive service than was actually rendered, billing for several services that should be combined intone billing, or billing twice for the same medical service.
    • Examples:
      • Billing single psychotherapy rates for group therapy
      • Physician billing for therapies performed by paraprofessionals
      • Dispensing generic drugs and billing for brand-name drugs or dispensing partially filled prescriptions without crediting Medicaid for the remainder.
      • Kickbacks - giving or accepting something in return for medical services or referrals.
      • Failing charge a co-payment, when co-pay is required, or charging a Medicaid recipient additional amounts for services that are fully covered under the Medicaid benefit.
      • Providing or prescribing medically unnecessary services or drugs.
      • Writing prescriptions in the name of a Medicaid patient for the treatment of a third party.
      • Filing false cost reports.
      • Billing for ambulance runs when medical service is provided, or transporting multiple passengers in ambulance and billing a run for each passenger.

What is Patient Abuse, Mistreatment or Neglect?

To report Medicaid Fraud, Patient Abuse or Neglect, or Drug Diversion, please call:
(401) 222-2566 or (401) 274-4400 extension 2269