How to Report Medicaid Fraud

Step-by-Step Guide

1. 1

   Step 1: Compare your Explanation of Benefits to your own records.

   Make a note whenever you receive medical supplies or services, and make sure the entries on the EOB match up with your own records and information about the services or supplies you received.Entries on your EOB that you don't understand, or dates that are unfamiliar, potentially could be evidence of Medicaid abuse or fraud.
2. 2

   Step 2: Contact your health care provider.

   If you find discrepancies on your claim forms, bring them up with your health care provider to rule out innocent error.
   
   While a strange entry on your EOB may be evidence of fraud, it also might be the result of a simple clerical mistake.
   
   It also may be that you simply don't understand the codes or descriptions used, but that they are perfectly legitimate.
   
   Your health care provider may be able to explain them to you., For the state agency or other authority to thoroughly investigate your report, you must provide details about the accounts and the potentially fraudulent charges.
   
   Pertinent information may include the names and Medicaid numbers of affected Medicaid clients, the names and contact information of the health care providers, and details about the services or supplies at issue, including dates and amounts.If you have a relative in a nursing home and see unauthorized withdrawals from their Medicaid fund account, it may be evidence of fraud., Each state has different agencies and government entities responsible for investigating Medicaid fraud.The Centers for Medicare and Medicaid Services (CMS) has a list of contact information for the specific agency in each state that investigates fraud reports at https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/FraudAbuseforConsumers/Downloads/smafraudcontacts-oct2014.pdf.
   
   You also can find contacts within your state by using the CMS contacts database at https://www.cms.gov/apps/contacts/.
   
   Typically you want to contact your state's Medicaid Fraud Control Unit, which usually operates as part of the Offices of State Attorneys General.MFCUs typically have statewide authority to prosecute criminal Medicaid fraud.However, in some states, the federal agency undertakes the actual investigation of any allegations of possible criminal activity.The Affordable Care Act also requires states to suspend Medicaid payments where there has been a credible allegation of fraud, thus mitigating the possible damages that could come from continued fraudulent charges while your report is being investigated., You typically can file your report either over the telephone or online.Your state agency may have a form you can fill out online, or you may be able to submit your form using email.
   
   If the form has blanks for your name or number, usually they will not be required to submit your report., The investigators may contact you after you file your report with requests for additional information.
   
   Typically you can remain anonymous when making your report.
   
   However, if you don't provide your name and contact information, investigators will be unable to contact you if they need any further information to complete their review of your report.
3. 3

   Step 3: Gather as much information as possible.

4. 4

   Step 4: Find contact information for your state.

5. 5

   Step 5: File your report.

6. 6

   Step 6: Respond to any follow-up questions.

Detailed Guide

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