FAQ > Health Care Fraud FAQs > What is Medicaid Fraud?
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What is Medicaid Fraud?
The medical assistance program, or Medicaid, is a vital program that provides health care benefits to low income and medically fragile Ohioans of all ages. The program is administered by the Ohio Department of Job and Family Services, which contracts with providers (e.g. doctors, dentists, hospitals, nursing homes, and medical equipment suppliers, etc.) to deliver needed goods and services to eligible Medicaid recipients, and then reimburses the providers for the goods and services they deliver.
When providers knowingly make false or misleading statements in association with claims for reimbursement of goods or services under the Medicaid program, they commit the criminal offense of Medicaid Fraud, codified in Ohio law at Revised Code Section 2913.40. Examples of Medicaid Fraud schemes include: billing for products and services not delivered; billing for a more expensive product or service than was actually delivered; billing separately for services that should be billed together; billing twice for the same product or service; dispensing generic drugs and billing for brand-name drugs; denying services to eligible recipients or not providing the level of service medically necessary/required; and submission of false information on Medicaid cost reports. The statute also prohibits Medicaid providers from charging co-pays and prohibits the payment of kickbacks or rebates in connection with the delivery of goods or services for which Medicaid reimbursement is sought.
We all share the cost of this $23 billion a year program, and provider fraud costs the taxpayers of this state millions of dollars each year, depriving the neediest among us of the care necessary to maintain quality of life. Attorney General Yost is committed to fighting fraud and corruption in state government and the programs for which our elected officials have statutory responsibility. Ohio’s Medicaid Fraud Control Unit is recognized as one of the finest and most effective in the country, and we are working every day to safeguard the tax dollars you have entrusted to our care.
If you suspect Medicaid Fraud, or have specific knowledge of corrupt or deceptive practices by Medicaid providers, you should contact the Ohio Attorney General’s Medicaid Fraud Control Unit at 614-466-0722, or the Attorney General’s Help Center at 800-282-0515.