Medicaid Fraud

Under the Ohio Revised Code 2913.40, Medicaid fraud occurs when an individual "knowingly makes or causes to be made a false or misleading statement or representation for use in obtaining reimbursement from the medical assistance program." Some examples of fraudulent activity include:

  • An agency bills for services to an individual for a week while the person is in the hospital
  • A provider bills for units of services not rendered
  • An agency submits claims for services to an individual for any day after they stopped providing services
  • A provider bills in excess of 24 hours per day;
  • An independent provider bills for 2 individuals at the same time in different locations;
  • A provider pays the family a "kick back" for not reporting they are billing for services they did not provide
  • A provider bills for services not authorized in the individual's plan
  • A provider misrepresents the service delivery ratio in order to receive a higher rate of pay

Consequences for Medicaid fraud convictions may include:

  • Federal exclusion from participating in federally funded health care programs. For more information, please visit the federal Office of the Inspector General's website.
  • Licensure/Certification revocation or suspension
  • Attorney fees
  • Investigative costs

Report Medicaid Fraud

To report fraud to DODD:

You also may make an anonymous complaint to the Ohio Attorney General's Office Health Care Fraud Section:

  • Call 800-282-0515
  • Submit a report online
  • Fax 877-527-1305
  • Send documentation to:
    • Medicaid Intake Officer
      Office of the Attorney General
      150 E. Gay St., 17th Floor
      Columbus, OH 43215
      Fax: 877-527-1305

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