What is Recipient Fraud?
STOP FRAUD, WASTE & ABUSE!
Only a small number of Medicaid recipients commit recipient fraud, but the actions of a few affect everyone. Recipient fraud can occur when a recipient fails to report correct information to the Department of Workforce Services (DWS) and receives Medicaid eligibility and benefits for which they are not entitled.
When benefits are received unfairly, it hurts everyone!
Program Integrity wants you and your family to get the health care you need. The identification of fraud, waste or abuse and the recovery of overpayments help put money back into the Medicaid system for those that need care.
HOW TO REPORT RECIPIENT FRAUD, WASTE & ABUSE
Medicaid providers, recipients, and the public need to work together to identify fraudulent activity. If you believe a Medicaid recipient has participated in any of the examples listed below or any other questionable activity, please report it to the Payment Error Prevention Unit at the Department of Workforce Services.
Contact Information Below:
Department of Workforce Services
Payment Error Prevention Unit
DWS Information Fraud Hotline
You may also report suspected Recipient Fraud, Waste or Abuse to the Department of Workforce Services.
Helpful Information to Know . . .
When Reporting Fraud, Waste & Abuse -
Before making your referral, gather as many facts as possible. Good information to know includes:
- Medicaid Recipient Name
- Date of Birth
- Phone Number
- Medicaid Recipient ID Number
- Social Security Number
- Employment Information
- Other details about what you suspect may be happening that appears to be wrong.
Callers may remain anonymous when reporting suspected fraud.
When conducting an investigation, it is helpful if the investigator can contact you if there are questions about your referral. You may request that your name not be used in conjunction with the case.
HELP ENSURE MEDICAID FRAUD IS IDENTIFIED & STOPPED!
Examples of Recipient Fraud
Public Assistance Fraud includes . . .
Food Stamps, Child Care, Financial Aid, and Medicaid services. It is considered Recipient Fraud when a person:
- Uses another Medicaid recipient's card with or without their knowledge.
- Loans a Medicaid ID card to other people to uses.
- Uses more than one Medicaid identification card.
- Doctor shops to get multiple services or prescriptions.
- Forges or changes a prescription.
- Does not use items received through the Medicaid program as intended.
- Sells medical items and supplies for profit.
- Asks for and receives services or supplies that are not needed.