MEDICAID PROVIDER FRAUD

Thumbnail image of Medicaid Fraud Flier - Click to View PDFThe Medicaid Fraud Control Unit has two principal objectives. Its primary mission is to investigate allegations of fraud committed by Medicaid providers. Additionally, the Unit investigates and prosecutes allegations of abuse or neglect in Medicaid funded facilities. The Unit does not investigate allegations of fraud committed by Medicaid participants and it does not investigate fraud perpetrated against the Medicare program.

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FAQs about Medicaid Fraud

  • What is Medicaid provider fraud?

    Medicaid providers include doctors, dentists, hospitals, nursing homes, pharmacies, clinics, counselors, personal care/homemaker chore companies, and any other individual or company that provides services to Medicaid participants. Provider fraud occurs when a provider misrepresents the services rendered and thereby increases the reimbursement from Missouri Medicaid.

  • What are some examples of provider fraud?

    • Billing for any services not actually performed, known as phantom billing;
    • Billing for a more expensive service than was actually rendered, known as upcoding;
    • Billing for several services that should be combined into one billing, known as unbundling;
    • Billing twice for the same medical service;
    • Dispensing generic drugs and billing for brand-name drugs;
    • Giving or accepting something in return for medical services, known as a kickback;
    • Bribery;
    • Billing for unnecessary services;
    • Submitting false cost reports; and
    • Falsifying timesheets or signatures in connection with the provision of personal care or consumer directed home health services.
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  • How can I report suspected Medicaid provider fraud?

    You may report Medicaid provider fraud by using any of the following methods:

    Missouri Attorney General's Office
    Medicaid Fraud Control Unit
    P.O. Box 899
    Jefferson City, MO 65102

    If you are the original source of information used by the Attorney General to file a civil suit against a Medicaid provider, you may be entitled to 10 percent of the State’s share of the amount recovered as a result of the suit.