Medicaid Recipient Information

THE MEDICAID PROGRAM IN NEW YORK STATE

Medicaid is a program for New York State residents that provides medical care. Medicaid recipients are very important to the New York State Office of the Medicaid Inspector General (OMIG). OMIG's job is to protect recipients and the resources of the Medicaid program.  

Medicaid fraud is not a victimless crime.  Intentionally deceiving or misrepresenting others for unauthorized benefits can jeopardize your medical care, waste taxpayer dollars, and is against the law.

EXAMPLES OF HEALTH CARE PROVIDER FRAUD OR ABUSE

• Billing for Medicaid services that were not provided or billing for the same service multiple times
• Giving out or selling unnecessary prescriptions
• Ordering unnecessary tests
• Giving money or presents to recipients in return for agreeing to get medical care
• Accepting kickbacks for patient referrals

EXAMPLES OF RECIPIENT FRAUD OR ABUSE

• Doctor shopping or visiting emergency rooms to get controlled drugs
• Getting medical help that is not needed
• Receiving gifts or money for getting medical services
• Lending your Medicaid card or using someone else's card
• Forging a prescription
• Receiving Medicaid when you are ineligible
• Not reporting other health insurance
• Altering bills or receipts

CONSEQUENCES OF IMPROPER USE OF YOUR MEDICAID CARD

• Someone else’s personal or medical information could be placed in your medical records and can lead to mistakes when you need treatment.
• Medicaid may not pay for the care you need if they already paid for the same care for someone else using your card information.
• You or whomever uses your card can be penalized up to ten years in prison and fined up to $500,000.

Source: https://omig.ny.gov/information-resources/recipient-resources

HOW TO REPORT FRAUD, WASTE OR ABUSE:

Madison County maintains a 24/7 Confidential Hotline at 1-855-83-FRAUD (1-855-833-7283). Reports may be made anonymously.

You can also report fraud, waste, or abuse, to the OMIG by filing online or calling the Medicaid Fraud Hotline at 1-877-87-FRAUD (1-877-873-7283).