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Strategies to Prevent Medicaid Fraud by Providers

Medicaid is a program designed to help Americans who cannot afford health care coverage otherwise. Some health care providers take advantage of the program with fraudulent billing practices, Medicaid fraud costs U.S. taxpayers billions of dollars each year, and Medicaid patients are usually in the best position to spot it and put an end to it.

  1. Study Your Bills

    • The Centers for Medicare & Medicaid Services recommends that consumers take a close look at medical bills that are submitted to Medicaid. Consumers should make sure that all services listed on the bill are services that they received. One of the most common forms of Medicaid fraud occurs when a provider bills Medicaid for services a patient did not receive. A consumer should report such billing discrepancies.

    Protect Your Medicaid Number

    • Share your Medicaid number with your doctor and his billing office--and no one else. If your number gets into the wrong hands, it could be billed fraudulently. This is another common type of Medicaid fraud, according to the Centers for Medicare & Medicaid Services.

    Before You Sign ...

    • Read everything you sign at a doctor's office. Never sign a blank form, even if the doctor tells you what he will write on the form. Request a copy of the forms that you sign for your own records.

    Know What Medicaid Covers

    • Understand your Medicaid coverage and know what is considered a covered service. If a doctor treats you for a non-covered service but bills it as a covered service, he has committed Medicaid fraud.

    Decline Services You Don't Need

    • Medicaid fraud sometimes takes the form of giving a patient services she does not really need or administering procedures that are not medically necessary. Consumers have the right to decline services and they have the right to a second opinion if they think services are unnecessary.

    Report Suspected Cases of Fraud

    • If you think your doctor may be committing Medicaid fraud, you should report it. Contact your state department of insurance and call the U.S. Department of Health and Human Services tip line at 800-HHS-TIPS (800-447-8477). You can remain anonymous.

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