Medicaid provider fraud has many forms and the OMIG welcomes the cooperation of diligent honest providers, Medicaid recipients and individual citizens to uncover this type of activity. One way for a recipient of medical services to assist us in identifying fraud is to keep a record of the following: 

• When a professional service is used;
• Where the service takes place;
• Who takes care of you;
• What services are provided during the visit; and
• What additional services were ordered by the provider.
  

Billing Medicaid for more services than were actually provided, constitutes fraud. If a recipient suspects a provider of Medicaid fraud, he or she should report it to us.

Examples of Provider Fraud

Some examples of provider fraud include:

• Billing for services that were not provided, e.g., a chest x-ray that was not taken.
• Duplicate billing which occurs when a provider bills Medicaid and also bills private insurance and/or the recipient.
• Requiring the recipient to return to the office for more visits when another appointment is not necessary.
• Taking unnecessary x-rays, blood work, etc.
• Upcoding, e.g., providing a simple office visit and billing for a comprehensive visit.
• Having an unlicensed person perform services that only a licensed professional should render, and bills as if the professional provided the service.
• Billing for more time than actually provided, i.e., counseling, anesthesia, etc.
• Billing for an office visit when there was none, or adding additional family members' names to bills.
• Accepting payment from another provider, including sharing in the reimbursement paid by the Medicaid program, as a result of referring a patient to the other provider.