Medicaid Fraud
Medicaid is a federal and state cost-sharing program that provides health care to people who are unable to pay for such care. Medicaid providers can be any person, group of people, or health care facility that supplies medical services to Medicaid recipients. Providers include doctors, medical equipment companies, podiatrists, dentists, licensed professional counselors, hospitals, adult day care centers, nursing homes, clinics, pharmacies, ambulance companies, case management centers, and others.
Sadly, unscrupulous medical providers sometimes steal from Medicaid. The state does not tolerate fraud and neither should you. The Attorney General's Office encourages you to review the following information and help report suspected Medicaid fraud.
Medicaid fraud affects everyone
Every Hoosier taxpayer pays for the cost of this crime. Indiana has to cover fraud losses by decreasing other government services and raising taxes. To keep costs as low as possible, to ensure that tax dollars are being spent properly and to ensure that less-fortunate Hoosiers get the health care services they need and deserve, the Medicaid Fraud Control Unit (MFCU) polices unscrupulous practices and enforces state health care laws. As a division of the Attorney General’s Office, the MFCU investigates three main areas of concern:
- Medicaid provider fraud
- Misuse of Medicaid recipients’ funds
- Patient abuse and neglect in board and care facilities
Common examples of Medicaid fraud include:
- Billing for nonexistent patients or patients of other providers
- Billing for services not provided
- Billing for unnecessary treatment or testing
- Billing for medical services that are actually provided by unlicensed or excluded personnel
- Accepting kickbacks for referrals
- Billing for lengthy counseling sessions when only short sessions are provided
- Making a patient pay more than a Medicaid-approved co-payment for services
How to spot Medicaid fraud
- If you receive an Explanation of Benefits (EOB) from Medicaid, read it carefully and tell the Medicaid office or the Attorney General's MFCU if you did not receive the listed services.
- If a provider suggests treatments or services that you do not believe are necessary, be cautious of the recommendation. Ask for a second opinion.
- If you have a relative in a nursing home, regularly check their funds account for unauthorized withdrawals.
Report Medicaid fraud
Recognizing and reporting Medicaid fraud is a civic duty we all share. Anyone who observes, is aware of, or receives a complaint from any source alleging Medicaid fraud can report it to the MFCU. If you suspect fraud, complete the Medicaid fraud complaint form or call the Indiana Attorney General's Medicaid Fraud Control Unit at 800.382.1039.
You may report Medicaid Fraud anonymously, however providing your contact information to the MFCU so the staff may ask you for additional information may assist with the investigation of the alleged fraud.
Whistleblower Law
Indiana's whistleblower law allows an individual, a/k/a “whistleblower”, to collect a monetary reward for reporting Medicaid fraud under certain circumstances. The law allows whistleblowers with knowledge of fraud committed against Indiana to bring suit on its behalf. The whistleblower's reward can be as much as 15 - 30 percent of any money recovered. Learn more about how to become a whistleblower.
Report a health-care conviction
To report the criminal conviction of a health care provider (licensed or unlicensed), send an email to the Medicaid Fraud Control Unit. Enter the court’s case number and the name of the defendant in the subject or body of the email and send.
Medicare & Medicaid information
The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the U.S. Department of Health and Human Services. The MFCU does not investigate Medicare fraud as this crime is handled by the Department of Health and Human Services. You can learn more about the programs online at http://www.cms.hhs.gov/.
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