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