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

Health Care Fraud

Medicaid Fraud Schemes from the Office of Inspector General

The Department of Health & Human Services (HHS) established and oversees multiple health care programs, including Medicare and Medicaid. Within HHS is the Office of Inspector General (OIG), which is tasked with making sure criminals and fraudsters do not steal your Medicare and Medicaid funds. The OIG considers the Senior Medicare Patrol (and you) as an integral partner in the fight against fraudulent activity in our health care system.

ImageWhen a provider intentionally misrepresents the services rendered and thereby increases its financial reimbursement from Medicaid, fraud has occurred. Generally, Medicaid providers include physicians, physician assistants, nurse practitioners, podiatrists, dentists, hospitals, nursing homes, pharmacies, clinics, counselors, personal care/homemaker chore companies and any other individual or company that is paid by the Medicaid program. Medicaid fraud also encompasses nursing home abuse and neglect cases. This includes allegations of battery, sexual assault and failure to deliver services or medications, When Senior Medicare Patrol projects learn of possible Medicare fraud, they report it directly to the OIG.

Common Fraud Schemes

Report Suspected Fraud

To report suspected fraud, click here.