Medicaid Fraud Resources

Please see our list of frequently asked questions below. If you have questions or concerns, please use this form.

• How do I report suspected Medicaid provider fraud?

  Call the Office of the Indiana Attorney General's Medicaid Fraud Control Unit at 800-382-1039, or file a report on-line by clicking here, (https://indianaattorneygeneral.secure.force.com/MedicaidFraudComplaints/)

• How do I file a complaint about the abuse and/or neglect of a patient in a residential care facility?

  Call the Office of the Indiana Attorney General’s Medicaid Fraud Control Unit at 800-382-1039, or file a complaint on-line. In case of an emergency, call 911. (https://indianaattorneygeneral.secure.force.com/AbuseAndNeglectComplaints/)

  • Patient Abuse & Neglect Brochure
• What is Medicaid?

  The Medicaid Program provides medical benefits to Hoosiers who cannot afford to pay for medical care. Though the federal government establishes general guidelines for the Medicaid program, each state establishes its own program, including eligibility criteria. The Indiana Medicaid program is funded through federal, state and county funds. It represents a very large portion of Indiana’s annual budget – amounting to over $12.4 billion per year.

• What is a Medicaid fraud control unit?

  The Indiana Medicaid Fraud Control Unit (“MFCU”) is a division of the Office of the Indiana Attorney General and has statewide authority to investigate all violations of applicable state laws regarding fraud in the provision of medical assistance under the Medicaid program. Federal regulations require States to create Medicaid fraud control units to combat fraud in the Medicaid Program. In doing so, the MFCU has wide-ranging investigative powers in healthcare settings.

• What is the Medicaid Fraud Control Unit's jurisdiction?

  The Indiana MFCU's mission has two distinct and complementary parts: (1) to investigate and prosecute health care providers and Medicaid administrators who defraud the Medicaid program and (2) to investigate and prosecute those who abuse, neglect or mistreat residents in facilities paid to provide nursing and/or personal care services to one or more unrelated adults.

  In fact, the MFCU's jurisdiction extends to all such facilities — regardless of whether the patient is a recipient of Medicaid funding. When Congress created the MFCUs in 1977, it did so not only because of the evidence of massive fraud in the Medicaid program, but also because the horrendous examples of nursing home abuse and victimization. The MFCU has authority to hold accountable individuals or corporations who defraud the Medicaid program or abuse residents of health care facilities through both criminal prosecution and/or civil litigation.

• Does the MFCU handle questions relating to Medicaid benefits?

  No. If you have questions regarding Medicaid eligibility or benefits, you should contact FSSA. (https://www.in.gov/medicaid/members/)

• Does the MFCU investigate and/or prosecute Medicare fraud?

  Medicare is a federally funded health insurance program for individuals age 65 or older, individuals under age 65 with certain disabilities, and individuals of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant). The MFCU has jurisdiction to investigate Medicare fraud only with the consent of the Office of the Inspector General of the United States Department of Health and Human Services and only if the case as a whole is primarily related to Medicaid. To report Medicare fraud, contact: https://www.medicare.gov/forms-help-resources/help-fight-medicare-fraud/how-report-medicare-fraud

• Does the MFCU investigate and/or prosecute Medicaid recipient fraud?

  The MFCU investigates and/or prosecutes Medicaid recipient fraud only in conjunction with provider fraud investigations and prosecutions. FSSA and county Prosecutors have jurisdiction to prosecute individuals who filed false applications to receive Medicaid benefits.

• How to spot Medicaid Fraud?

  Medicaid recipients, or their family members and people who work for them, should closely monitor medical billing statements. Keep a lookout for unusual activity, such as:

  • charges for services that were never performed, or for goods you never received.
  • billing for the same thing twice.
  • services that were not ordered by your doctor.
  • providers who recommend/perform unnecessary services or tests.

  Medicaid fraud may also include:

  • a patient whose medication is missing.
  • unexplained cuts, black eyes, bruises or burns.
• What are typical Medicaid fraud schemes?

  Due to the amount of money expended by the Medicaid Program, the methods for theft of that money are limited only by the imagination of the criminal. However, it is common to see schemes deploying the following techniques:

  • Operating Medicaid “mills” – creating businesses for the main purpose of generating money by billing the Medicaid program regardless of the actual medical need of the patients in the community
  • Billing for medically unnecessary services
  • Selling prescriptions or access to prescription drugs for the purpose of abuse or misuse
  • Double-billing (billing both Medicaid and a private insurance company or the recipient directly, or multiple providers billing Medicaid for the same recipient for the same procedure)
  • Kickbacks  -- making financial arrangements between providers involving some financial benefit in return for another provider prescribing or using their products or services, which frequently results in unnecessary treatment
  • Falsely inflating reimbursement rates for large institutions such as nursing homes, hospitals or clinics  by falsifying  financial reports on which the rates are set
  • Employing healthcare professionals or other staffers who have been previously barred from government healthcare programs due to prior fraud or other abusive practices
  • Cheating patients by demanding cash payments on the side for services insured by Medicaid
  • Billing for services not rendered or “upcoding” by billing Medicaid for more expensive procedures than those that are actually performed
  • Overbilling for services paid by the hour – such as home health care – by submitting or approving false time records