WHY IT IS IMPORTANT
The Medicaid program is funded with both state
and federal tax dollars. It is designed to pay
for health care for low-income and vulnerable
Floridians (children, pregnant women, disabled adults and seniors)
who need care. When people get benefits they
don’t deserve, or when providers are paid for
services that were not supplied, it wastes your tax
dollars and takes services away from those who
WHAT IS MEDICAID FRAUD?
Medicaid fraud means an intentional deception or misrepresentation made by a health care provider with the knowledge that the deception could result in some unauthorized benefit to him or herself or some other person. It includes any act that constitutes fraud under federal or state law related to Medicaid. To report suspected Medicaid Fraud, please call the Attorney General toll-free at 1-866-966-7226. Find out if you are eligible for a reward. Callers may request to remain anonymous.
Medicaid Fraud Brochure.pdf (2mb), Medicaid Fraud Poster.pdf (3mb)
(SPANISH) Medicaid Fraud Brochure.pdf (2mb)
|THINGS YOU CAN LOOK FOR
Upcoding: Providers bill Medicaid using codes that describe the amount of time spent with the
patient. If a patient sees a health care provider for ten (10) minutes on a simple matter and the
provider bills for an hour-long, complex visit, that is upcoding.
Unbundling: Some billing codes used by providers are all-inclusive and “bundle” several laboratory
tests into one code. If the provider breaks the bundled code into several parts to achieve a higher
reimbursement rate, that is unbundling. For example: A Lipid Panel is a laboratory test that includes
three different component tests. Unbundling occurs when the three component tests are billed
instead of the Lipid Panel.
|WHAT FRAUD LOOKS LIKE
Most providers who commit Medicaid fraud fall into one or more of these categories:
- billing for patients who did not really receive services,
- billing for a service and/or equipment that wasn’t provided,
- billing for items and services that the patient no longer needs,
- overcharging for equipment or services,
- concealing ownership or associations in a related company,
- paying a “kickback” in exchange for a referral for medical services or equipment,
- billing more than once for the same service,
- using false credentials such as diplomas, licenses or certifications, or
- ordering tests or prescriptions that the patient does not need.
|HOW TO REPORT FRAUD
You can help protect your tax dollars by reporting suspected fraud by phone, through the Internet or by regular mail. You can do this without giving your name, but if you agree to give your name and other contact information, that helps the investigators to obtain future information.
Before you make a report, try to get as much information as possible, including:
- the name of the person you suspect of committing fraud. This might be a person receiving medical benefits or a health care professional hospital, nursing home, or other facility that provides Medicaid services
- the Medicaid ID number
- the date of services
- the amount of money involved, and/or
- a description of the acts that you suspect involve fraud
|WHAT YOU DO TO PREVENT FRAUD
- Do not give your Medicaid card number to anyone except your doctor, hospital or other health care provider
- Do not ask your doctor or other medical provider for medical care you do not need.
- Be suspicious if you are offered free screenings or tests in exchange for your Medicaid card number.
- Ask questions if someone wants you to have services or treatments that you feel you do not need. If necessary, get a second opinion from another health care provider.
- Do not accept money or gifts from anyone who offers to buy medicine that you have received through Medicaid.