Medicaid Fraud Control Unit

Medicaid Fraud Control UnitThe Arkansas Attorney General’s Office fights Medicaid fraud through its Medicaid Fraud Control Unit.

The Unit investigates and prosecutes violations of state and federal law involving Medicaid providers and the abuse or neglect of nursing home residents.

Medicaid fraud occurs when Medicaid providers use the Medicaid program to obtain money they are not entitled to. For instance, the Medicaid Fraud Control Unit arrested a northeast Arkansas woman in 2013 for falsifying time sheets that were the basis for her employer to receive Medicaid reimbursement.

Providers who are convicted of Medicaid Fraud may lose their eligibility to be a provider in the Arkansas Medicaid Program and may have their professional licenses revoked. Convictions may also carry prison terms and large fines.

Examples of types of Medicaid fraud

  • Billing for Services Not Rendered: A provider bills for treatments or procedures which are not actually performed.
  • Billing for Unnecessary Services: A provider misrepresents or falsifies a patient’s diagnosis and symptoms on recipient records and billing invoices to obtain payment for
    unnecessary services.
  • Substitution of Generic Drugs: A pharmacist fills a recipient’s prescription with a generic drug or an over-the-counter drug but bills Medicaid for a higher cost name-brand drug.
  • Kickbacks: A Medicaid provider (such as a hospital, a transportation company or a laboratory) offers or pays kickbacks to another Medicaid provider’s employees for
    referring a Medicaid recipient to the provider as a patient or a client. Kickbacks could be in the form of cash, trips or merchandise.
  • Double Billing: A provider bills both Medicaid and the recipient (or private insurance) for the same service, or two providers bill for the same service.
  • Other Unauthorized Billing: A provider charges a Medicaid recipient for a service which is covered by and should be billed to Medicaid, or charges a recipient the difference between the provider’s usual fee and what Medicaid pays.

The Department of Human Services administers the Arkansas Medicaid program. For detailed information about the Arkansas Medicaid Program please visit www.medicaid.state.ar.us.

The MFCU also monitors and takes action regarding the abuse or neglect that a Medicaid recipient may suffer in long-term health-care facilities. There are times that Medicaid residents, especially the elderly, are physically and sexually abused or neglected by health care workers. Physical abuse or neglect includes anything from striking to sexually assaulting a resident, to withholding necessary and adequate food, physical care or medical attention. Financial abuse includes the misuse of a resident’s trust funds to pay for nursing home services already being paid for by the Medicaid Program or for uses of a resident’s funds not authorized by the resident or the resident’s guardian, trustee or administrator.

The Medicaid Fraud Control Unit accepts complaints regarding Medicaid Fraud and Abuse and Neglect. A report can be filed here.

Office of Long Term Care
Department of Human Services

Abuse Complaint Section
P.O. Box 8059, Slot 400
Little Rock, AR 72203-8059
Phone: (501) 682-8430
Email: OLTC2@arkansas.gov

Statewide Long-Term Care Ombudsman
Division of Aging and Adult Services
Department of Human Services

1417 Donaghey Plaza South
Little Rock, AR 72201
Phone: (501) 682-8952
Webpage: http://www.arombudsman.com/contact.html

Office of the Medicaid Inspector General
700 South Main Street
Little Rock, AR 72203-1437
Phone: (501) 682-8349
Webpage: http://omig.arkansas.gov/