Medicaid Fraud and Patient Abuse
Examples of Medicaid fraud include:
- Billing for medical services not actually performed.
- 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.
- 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.
To report Medicaid Fraud, Patient Abuse or Neglect, or Drug Diversion, please call:
(401) 222-2566 or (401) 274-4400 extension 2269