Consumers can use this form to report a health care provider that you think may be committing Medicaid fraud. Providers can also use the form to report consumers that they think may be committing Medicaid fraud.
Here are some examples of Medicaid fraud:
- Filing claims for services or items not provided
- Tampering with prescriptions
- Using stolen Medicaid numbers
- Filing claims for visits that didn't happen
- Adding charges that don’t exist
- Selling supplies/equipment/medications that were paid for by Medicaid
- Giving false information
- Medical records
- Claims
- Applications
- Identity of provider or patient
Medicaid abuse includes doing things that may result in unnecessary costs to Medicaid. Some examples of provider or beneficiary abuse include:
- Not reporting all of your income, assets, resources, etc.
- Using Vermont Medicaid when you live in another state
- Going to several doctors to get prescription drugs (drug seeking behaviors)
- Using more health care services than are needed
- Selling products, medications and/or supplies that were paid for by Medicaid
- Excessive charges for services or supplies
- Claims for services that are not medically necessary
- Billing for services not provided
- Inaccurate coding
- Misrepresenting professional credentials/licensing/status of licensure
