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Reporting Fraud and Abuse

DHCF investigates activities relating to the prevention, detection, and investigation of alleged provider and recipient fraud and/or abuse in the Medicaid program. Controlling fraud and abuse means more dollars are spent funding critically needed programs and medical procedures. Click here to report Fraud and Abuse

Examples of Provider Fraud

  • Billing for services not rendered

  • Billing for services not medically necessary

  • "Upcoding" or inappropriate billing that results in a loss to the Medicaid program

  • Inappropriate or lack of documentation to support services billed

  • Quality of care issues that fail to meet professionally recognized health care standards

  • Falsifying certificates of medical necessity, plans of treatment, and medical records to justify payment

  • Soliciting or receiving kickbacks; and/or ,

  • Violating Medicaid policies, procedures, rules, regulations, and/or statutes

Examples of Recipient Fraud

  • Excessive use or overuse of Medicaid

  • Using another's Medicaid Identification card

  • Lending, altering or duplicating a Medicaid ID

  • Providing incorrect eligibility or false information to a provider to obtain treatment

  • Simultaneously receiving benefits in DC and another state

  • Knowingly assisting providers in rendering services to defraud the Medicaid program

  • Prescription fraud