The National Consumer Protection Technical Resource Center: The Center of Service & Information for SMPs

Health Care Fraud

Medicaid Fraud

Medicaid is a health care program funded jointly by the federal and state governments. The Medicaid program is vulnerable to fraud, waste, and abuse for the same reasons that the Medicare program is vulnerable. Medicaid beneficiaries may be any age. Approximately 15 percent of Medicare beneficiaries also qualify for Medicaid and are considered “dually eligible.” 

CMS Educates Medicaid Beneficiaries to Prevent, Detect, and Report Medicaid Fraud

To combat Medicaid fraud, the Centers for Medicare & Medicaid Services (CMS) has established a Medicaid Program Integrity Program. As part of CMS’ anti-fraud efforts, a presentation and videos have been developed to educate Medicaid beneficiaries to:

  • Spot Medicaid fraud
  • Understand the dangers of “beneficiary card sharing”
  • Protect themselves and their card
  • Report fraud

Click here to access the presentation and videos.

SMPs Partner to Prevent, Detect, and Report Medicaid Fraud

SMP projects often partner with their state ombudsman programs to help Medicaid beneficiaries who live in nursing homes or other facilities. SMPs report suspected Medicaid fraud to state Medicaid Fraud Control Units (MFCUs), which investigate and prosecute health care providers and also look into complaints of abuse and neglect. At the national level, the SMP program also partners with the Office of Inspector General (OIG) for both educational and reporting purposes. The OIG has identified some common Medicaid fraud schemes.

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