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Attorney General

VIOLENCE AGAINST THE ELDERLY



MEDICAID FRAUD 

Elderly Abuse & Exploitation
Elderly Abuse Report
Patient Abuse
Medicaid Fraud
 
Related:
Safeguarding 
your finances
Elderly Abuse 
& Exploitation
The State of Delaware and the Federal Government have designated the Medicaid Fraud Control Unit (MFCU) to investigate and prosecute illegal acts relating to Medicaid funds. Created in 1977, the MFCU, which is housed within the Delaware Department of Justice, was designed to protect the Delaware residents who receive Medicaid and the taxpayers who support the program. The MFCU has a professional staff of prosecutors, investigators and auditors who review allegations involving:

Medicaid Fraud: criminal fraud against the state by healthcare providers who treat Medicaid recipients.

Patient Abuse, Neglect or Mistreatment: criminal abuse, neglect or mistreatment of patients in health-care residential facilities, including nursing homes and mental health residential facilities.

Financial Exploitation: theft or misuse of Medicaid recipients' funds by those employed in long-term care facilities.


WHAT IS MEDICAID?

Medicaid is a federal/state cost-sharing program that provides healthcare to people who are unable to pay for such care. The Delaware Medicaid program is administered by the Delaware Department of Health and Social Services.

The MFCU does not investigate fraud committed by Medicaid recipients; such cases should be referred to the Welfare Fraud Unit (Audit recovery management systems) within the Department of Justice.

WHAT IS MEDICAID PROVIDER FRAUD?

Medicaid providers include doctors, dentists, hospitals, nursing homes, clinics, pharmacies, ambulance companies and anyone else who is paid by Medicaid for a healthcare service. Fraud by a Medicaid provider is usually evidenced by one or more of the following:

 UPCODING - when healthcare providers bill Medicaid for a more expensive treatment or service than the one they actually provided to the patient; or by filling a prescription with a generic drug, while billing for the more expensive name brand version of the medication;

 PHANTOM BILLING - billing for goods or services not provided, such as
billing for patient visits that never took place or for blood tests when no
samples were taken;

 UNNECESSARY SERVICES - billing for unnecessary services can
include billing for items that patients do not need at all, such as oxygen
concentrators, hospital beds or wheelchairs;

 DOUBLE BILLING - billing Medicaid twice for the same procedure,
sometimes by submitting a bill at the beginning of the month and a
second bill at the end for the same service;

 UNBUNDLING - submitting bills for individual procedures as if the service
were performed on different days for procedures that the doctor
performed during one day as part of one operation;

 KICKBACKS - when medical suppliers, home health agencies, etc., give
kickbacks to physicians who recommend their business to patients; or
when corrupt doctors demand under-the-table cash payments from
patients.

Acts like those described above may violate state and federal laws and subject
the guilty provider to imprisonment, significant fines and exclusion from the Medicaid
program.

HOW DOES MEDICAID FRAUD AFFECT ME?

Medicaid fraud affects everyone. When providers steal from Medicaid, they
decrease the resources available to the program. Residents living near the poverty
level, who would have been qualified for the program, might be excluded because of a
lack of resources. Medicaid fraud also reduces the quality of treatment as dishonest
providers try to reduce costs and increase personal profit. To compensate for the
fraud, the state must either decrease services in other areas or raise taxes.

HOW CAN I SPOT MEDICAID FRAUD?

Many of the cases prosecuted by the MFCU start with information from the public.
Here are several hints to help detect fraud:

 if a provider suggests treatment or services that you do not realistically believe are necessary, be cautious of the recommendation;

 if you receive Medicaid and are in a healthcare facility, check your personal funds account regularly;

 if you are visiting in a healthcare facility, pay attention to the patient's appearance and the appearance of the room and the facility or any other indication of neglect.

 

Victim Contact Information
Victim Contact Information
24-Hour Hotlines
 
Domestic Violence: 
Rape Crisis Contact: 
Mobile Crisis Unit: 
Child Abuse Hotline: Abriendo Puertas: 
Northern Kent: 
Kent/Sussex Counties:
 302-762-6110  800-262-9800  800-652-2929  800-292-9582  302-745-9874  302-678-3886  302-422-8058

Full Victim Contact List


Related Links
Related Media:
Family Division 
Press Release

   

Related Links:

Family Division Units

For the Parents




Last Updated: Thursday, 18-Oct-2007 18:19:19 EDT
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