The Medicaid program is made up of a network of health care providers, coordinators and services that help millions of New Yorkers every year. This includes direct care providers and managed care plans that coordinate services. The vast majority of health care professionals and organizations in the Medicaid program want to follow the rules. Providers who have engaged in unacceptable practices cannot participate in the Medicaid program. As an aid to health care professionals and organizations, OMIG provides access to the list of these providers under Medicaid Exclusions.
Providers may also see fraud in their day to day activities. Some examples of fraud may include:
- Billing for unnecessary services – Ordering and then subsequently charging the Medicaid program for services a patient does not need;
- "Phantom" billing – Billing Medicaid for services or for dispensing products that the patient never received, such as patient visits that never took place, dental fillings for teeth that had previously been extracted, medical equipment that was never delivered;
- Multiple billing – Intentionally sending bills to Medicaid for the same procedure or office visit more than once;
- Improper Upcoding – Intentionally billing Medicaid for a more expensive treatment or medication than the one the patient actually received;
- Kickbacks – When Medicaid providers give money, items of value, or other considerations to other healthcare providers in exchange for referrals or for business; and
- Selling drugs/forging or altering prescriptions – When a Medicaid patient fills a legitimately authorized prescription, written by an authorized physician, and then sells the contents for profit, that is fraud. Altering the amount of the prescription, or stealing a prescription pad from a doctor and then using is also fraud.
Providers can contact the Medicaid Fraud Hotline by calling 1-877-87 FRAUD (1-877-873-7283) or by by clicking "File an Allegation."