Medicaid Fraud Control Unit
Download the Medicaid Fraud Control Unit brochure
Many Hoosier families struggle financially and can't afford to pay for essential health care services. In these instances, Medicaid covers the cost of necessary medical treatments with state and federal funds.
To keep costs as low as possible, and to ensure tax dollars are being spent properly, 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 Medicaid facilities
In the end, the efforts of this division do more than save money: they ensure that less-fortunate Hoosiers get the health care services they need and deserve.
What is Medicaid fraud?
Medicaid pays the medical costs of many Hoosiers who cannot afford health insurance.
Sadly, unscrupulous medical providers sometimes steal from Medicaid. Providers, including doctors, dentists, and hospitals may:
- Bill for services that were never provided
- Over-bill for services that were provided
- Bill for tests, services and products that were unnecessary
Does Medicaid fraud affect me?
Medicaid fraud affects everyone!
The more unscrupulous providers steal, the less Medicaid money is available for the poor who need it. Some may be excluded from the program altogether. Others may suffer a loss of available services. Patients treated by a fraudulent provider may face more problems because of inadequate medical treatment.
In fact, every Hoosier taxpayer pays for the cost of this crime. Indiana has to cover fraud losses by decreasing other government services and raising taxes.
The usual suspects: Common forms of Medicaid Fraud and suspicious activity
- Billing for nonexistent patients or patients of other providers
- Billing for services not provided
- Billing for used medical equipment as though it were new
- Billing for unnecessary treatment or testing
- Billing for physicians' services that are actually provided by unlicensed personnel
- Accepting kickbacks from referrals
- Billing for lengthy counseling sessions when only short sessions were 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 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.
What to do if you suspect Medicaid Fraud
If you suspect fraud, call the Indiana Attorney General's Medicaid Fraud Control Unit at 800-382-1039.
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