FRAUD, WASTE AND ABUSE

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• Fraud is the intentional deception or misrepresentation that an individual knows, or should know, to be false, or does not believe to be true, and makes, knowing the deception could result in some unauthorized benefit to himself or some other person(s).

• Waste is the over-utilization of services that are not medically necessary or practices that result in unnecessary costs.

• Abuse describes provider practices that are inconsistent with sound fiscal, business or medical practices and result in unnecessary costs to Medicaid and Medicare.

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Examples of Fraud, Waste and Abuse include:

• Providing or accepting kickbacks.

• Falsifying provider credentials

• Fraudulent enrollment practices.

• Double billing, upcoding

• Billing for services not provided.

• Substitution of services.

• Not accurately reporting financial resources during enrollment.

• Misrepresentation of medical conditions.

• Failure to report third party liability coverage.

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Please fill out the form below to tell us about what you suspect. Be sure to give us a working phone number or a valid email address.