What is Medicaid Fraud, Waste and Abuse?
Learn about it from the New York State Office of the Medicaid Inspector General (OMIG). Read below or click here:
Medicaid fraud and abuse affects all New Yorkers by depleting valuable public funds meant to provide healthcare to vulnerable citizens. The New York State Office of the Medicaid Inspector General (OMIG) is a nationally recognized leader among Medicaid program integrity agencies. OMIG’s recovery efforts and cost-containment initiatives save hundreds of millions in taxpayer dollars each year.
New Yorkers can assist OMIG in fighting fraud, waste, and abuse by reporting potentially suspicious behavior or incidents. OMIG encourages anyone who observes instances of potential Medicaid fraud, waste, or abuse to contact OMIG’s fraud hotline. Tips can be completely anonymous—and OMIG investigates all reported information.
Healthcare fraud is not a victimless crime. It impacts all New Yorkers.
Taxpayers: Even the lowest estimates of healthcare fraud represent an enormous drain on the public health care system. Taxpayers in New York State and throughout the country pay the price.
Recipients: When a provider misrepresents his or her credentials and services, it can jeopardize your health. By falsifying or exaggerating a diagnosis, a doctor may add a condition to your medical record you don’t even have. You can be subjected to unnecessary or unsafe medical procedures, may receive the wrong medical treatment, or find that your health benefits have been exhausted.
Providers: The actions of a few deceitful providers ultimately damage the reputation of trusted and respected providers. Intentionally deceiving or misrepresenting others for unauthorized benefits can jeopardize your medical care, waste taxpayer dollars, and is against the law. The penalty for allowing a Medicaid care or number to be misused is up to ten years in prison and fines of up to $500,000.
RECIPIENT FRAUD, WASTE, AND ABUSE
Examples of recipient fraud include:
- Lending or sharing a Medicaid Identification card
- Forging or altering a prescription or fiscal order
- Using multiple Medicaid ID cards
- Re-selling items provided by the Medicaid program
- Selling or trading the card or number for money, gifts or non-Medicaid services
PROVIDER FRAUD, WASTE, AND ABUSE
OMIG reviews provider billing and other activities and investigates charges of fraudulent behavior.
Examples of provider fraud include:
- Billing for Medicaid services that were not provided
- Billing for unnecessary services
- Selling prescriptions
- Intentionally billing for a more expensive treatment than was provided
- Giving money or gifts to patients in return for agreeing to get medical care
- Accepting kickbacks for patient referrals
In addition to prison and repayment of Medicaid dollars, an unethical provider can also be placed on the Medicaid Exclusion list and barred from participating in the program.
How Do I Report Fraud Waste and Abuse?
If you suspect that a provider or recipient has committed Medicaid fraud, you can help by reporting it.
- Call SNH: 315-624-4545, 1-888-355-4764, TTY 1-800-662-1220
- Call Mohawk Valley Health System (MVHS) Corporate Compliance Office: 315-624-5146
- Write to SNH: 1650 Champlin Ave., ATTN: Compliance Office, Utica, NY 13502
- Report it Directly to OMIG: 1-877-87-FRAUD (1-877-873-7283) or report it online.
- Or, file a report with EthicsPoint. EthicsPoint is a third-party hotline provider Mohawk Valley Health System contracts with to handle reporting from employees, patients, and members confidentially. Call 1-800-954-9418 or visit mvhealthsystem.ethicspoint.com.