Healthcare fraud is costly, with experts estimating that losses due to healthcare fraud are in the tens of billions of dollars each year. Combating such fraud and abuse helps reduce the escalating costs of healthcare in New York and the United States.
Medicaid fraud is the intentional providing of false information to get Medicaid to pay for medical care or services.
Below are examples of both beneficiary fraud and provider fraud.
Beneficiary Fraud can include:
- Providing incorrect information to qualify for Medicaid
- Sharing your Medicaid identification (ID) card with someone else so they can obtain medical services
- Helping your doctor file false claims by having tests you know you do not need
- Altering a doctor’s prescription, going to multiple doctors to get more of the same drug, or selling your drugs to others
- Accepting payment from your doctor for referring other beneficiaries for medical services
- Altering or duplicating a Medicaid ID card and using it or selling it for someone else to use
If you suspect any cases of fraud, waste and abuse that involves your medical care, including vision, dental, behavioral health, or prescription drugs, please report it to us.
- Calling the Amida Care Compliance Hotline at 1-888-394-2285. We are here to help 24 hours a day, 7 days a week, 365 days a year. When you call the Hotline, you can leave your name and address, or you can remain anonymous.
- You can email us at: firstname.lastname@example.org
- You can write us at: Amida Care, Attn: Compliance, 14 Penn Plaza,
2nd Floor, New York, NY 10122
Amida Care takes reports of all suspected fraud, waste or abuse seriously. Amida Care reports all suspicious activity to the appropriate authorities.
Examples of Provider Fraud can include:
- Intentionally billing for services or items not provided
- Intentionally billing for unnecessary medical services or items
- Offering, soliciting, or paying for beneficiary referrals for medical services or items
- Writing unnecessary prescriptions, or altering prescriptions, to obtain drugs for personal use or to sell them
- Billing for services at a higher level of complexity than provided
- Billing for multiple codes for a group of procedures that are covered in a single global billing code
- Knowingly treating and claiming reimbursement for someone other than the eligible beneficiary
- Knowingly billing for an ineligible beneficiary
- Knowingly accepting multiple Medicaid ID cards from a beneficiary to claim reimbursement
Providers in New York State Medicaid must investigate, and report matters that involve possible fraud, waste and abuse or inappropriate payment of funds (overpayments) that they’ve identify to the New York State Office of Medicaid Inspector General (OMIG). Federal and New York State law requires Medicaid providers who have identified an overpayment to report the overpayment, the reason for the overpayment, and to return the overpayment within 60 days of identification (or by the date the correspondence cost report is due, if applicable). Providers who fail to report identified overpayments may be found liable under the False Claims Act, may have to pay civil monetary penalties or fines, and may no longer be allowed to participate in the Medicaid program. OMIG has developed the Self-Disclosure program to give providers an easy-to-use method for disclosing overpayments. For additional information and instructions, see Submission Information and Instructions.
Healthcare fraud is not a victimless crime. If you suspect that a provider or beneficiary has committed Medicaid fraud, you can help by reporting it. In addition to the Amida Care reporting methods outlined above, you can also file a report by calling: 1-877-87-FRAUD (1-877-873-7283) or report it online.
We all have an obligation to prevent, detect, report and correct fraud, waste and abuse. When it comes to fighting fraud, waste and abuse, YOU are part of the solution, and YOU make the difference!