Recipients

The Medicaid Program in New York State

Medicaid is a program for New York State residents that provides medical care. Medicaid recipients are very important to the New York State Office of the Medicaid Inspector General (OMIG). OMIG's job is to protect recipients and the resources of the Medicaid program.  

Medicaid fraud is not a victimless crime.  Intentionally deceiving or misrepresenting others for unauthorized benefits can jeopardize your medical care, waste taxpayer dollars, and is against the law.

When a Medicaid provider misrepresents his or her credentials and services, it can jeopardize your health.  By falsifying or exaggerating a diagnosis, you could be subjected to unnecessary or unsafe medical procedures, receive the wrong medical treatment, or find that your health benefits have been depleted for a condition you don’t even have.

You can assist OMIG in fighting fraud, waste, and abuse by safeguarding your benefits and reporting potentially suspicious behavior or incidents.  Tips can be completely anonymous and OMIG investigates all reported information.  To report fraud, waste, or abuse, file an allegation online or call the Medicaid Fraud Hotline at 1-877-87-FRAUD (1-877-873-7283).

Examples of Health Care Provider Fraud or Abuse
  • Billing for Medicaid services that were not provided or billing for the same service multiple times
  • Giving out or selling unnecessary prescriptions
  • Ordering unnecessary tests
  • Giving money or presents to recipients in return for agreeing to get medical care
  • Accepting kickbacks for patient referrals
Examples of Recipient Fraud or Abuse
  • Doctor shopping or visiting emergency rooms to get controlled drugs
  • Getting medical help that is not needed
  • Receiving gifts or money for getting medical services
  • Lending your Medicaid card or using someone else's card
  • Forging a prescription
  • Receiving Medicaid when you are ineligible
  • Not reporting other health insurance
  • Altering bills or receipts
Consequences of Improper Use of Your Medicaid Card
  • Someone else’s personal or medical information could be placed in your medical records and can lead to mistakes when you need treatment.
  • Medicaid may not pay for the care you need if they already paid for the same care for someone else using your card information.
  • You or whomever uses your card can be penalized up to ten years in prison and fined up to $500,000.
Explanation of Medical (Medicaid) Benefits Letters

Recipients of New York State Medicaid may receive a letter entitled "Explanation of Medical (Medicaid) Benefits" (EOMB).  The purpose of an EOMB is to ensure that the recipient received the service or services that NYS Medicaid has paid for and provide an opportunity for the recipient to communicate with OMIG regarding the services listed on the EOMB.  

If you receive an EOMB letter, please review the service(s) listed and make sure that everything is accurate -- including the date, the provider, and the services provided. 

If everything is listed correctly, there is no need for further action, and the EOMB should not be mailed back to OMIG.

If something is NOT listed accurately, or if there are other issues related specifically to the services listed on the EOMB, please explain the issue(s) in the comment box, and return the EOMB to OMIG using the postage-free envelope provided with the EOMB.

View an example of an EOMB.

Enrolling in Medicaid

You may be covered by Medicaid if:

  • You have high medical bills.
  • You receive Supplemental Security Income (SSI).
  • You meet certain financial requirements.

You may apply for Medicaid in the following ways:

More information about the Medicaid program and benefits is available through the New York State Department of Health (DOH) website, under Medicaid.