Office of Medicaid Fraud & Abuse investigates
provider fraud. Providers include medical doctors, dentists, hospitals, nursing homes, pharmacies, durable medical equipment sellers, ambulance companies, taxis, or anyone who bills the KY Medical Assistance Program for health care goods or services provided to a Medicaid recipient. The Office of Medicaid Fraud and Abuse has state and federal authority to bring both criminal and civil actions.
What are examples of fraud?
- Billing for medical services not actually performed
- Billing for a more expensive service than was actually rendered
- Billing for several services that should be combined into one billing
- Billing twice for the same medical service
- Dispensing generic drugs and billing for brand-name drugs
- Kickbacks - giving or accepting something in return for medical services
- Providing unnecessary services
- False cost reports
- Billing for ambulance runs when no medical service is provided
- Multiple passengers in an ambulance and separate billings for each passenger
Our Office of Medicaid Fraud and Abuse also prosecutes criminals who harm our vulnerable adults, including the elderly as well as adults with physical or mental disabilities. In addition to investigations and prosecutions, the Office of Medicaid Fraud and Abuse has provided education and outreach to communities to help empower individuals to identify and prevent abuse and neglect of Kentucky's seniors.