Tips for reporting Medicaid and Public Assistance Fraud
Public assistance programs, like Medicaid, Temporary Assistance, Food Stamps, Day Care and HEAP are a vital resource for many of our residents, but waste, fraud, and abuse in these programs cost YOU millions of dollars every year and short change those who need and deserve our help. Won't you please help us fight those who defraud and abuse these programs? If you know of any provider, business, or person engaged in questionable practices involving public assistance programs, let us know. Speak up! Working together we can make a difference
Public Assistance Fraud and Abuse in Warren County
Public Assistance programs like Medicaid are a vital source of help for many Warren County residents who need and deserve assistance. Unfortunately, there are those who take advantage of these programs and the people they serve by intentionally obtaining money and services they are not entitled to. In fact, the New York Times estimated that somewhere between 10% and 40% of the money spent on the Medicaid program alone is lost to waste, fraud and abuse. That's millions of Warren County taxpayer dollars down the drain!
What is Public Assistance Fraud and Abuse?
Fraud and abuse are any intentional actions which result in a recipient or provider receiving benefits or payments to which they are not entitled.
Programs Impacted by Fraud and Abuse
- Medicaid
- Temporary Assistance to Needy Families (TANF)
- Safety Net
- Food Stamps
- Day Care
- Child Health Plus
- Family Health Plus
- Home Energy Assistance Program (HEAP)
- Home Care
- Nursing Home Care
Medicaid and Public Assistance fraud is a serious crime that can result in imprisonment, probation, civil penalties, and restitution and render someone ineligible for benefits for a certain length of time.
What Is Warren County Doing To Help Combat Fraud And Abuse?
Warren County is committed to protecting the quality and integrity of the County’s Medicaid and Public Assistance programs. As such, the Department of Social Services is actively pursing fraud and abuse throughout the various programs. We've even created a special team of people who specialize in combating fraud and abuse.
Warren County’s Medicaid and Public Assistance Fraud and Abuse Program involves a cooperative effort between the Warren County Department of Social Services, the Warren County Sheriff's Office, and the Warren County District Attorney’s Office all working together to detect, prevent and deter fraud and abuse and to ultimately prosecute those individuals and providers who defraud or abuse the assistance system.
Types of Recipient Fraud:
- Providing false or incomplete information to the Department of Social Services at either the application or recertification phase.
- Falsely reporting that a parent is absent from the household.
- Falsely reporting that a child is in the household.
- Listing a non-relative as a family member in order to obtain benefits.
- Intentionally failing to report a change in the household composition.
- Intentionally failing to report earnings from employment or monies received from unemployment, disability or social security.
- Intentionally failing to disclose assets, including bank accounts and real estate.
- Submitting false or fraudulent documents to the Department of Social Services in order to get benefits.
- Using someone else’s benefits card to obtain treatment, services or benefits.
- Claiming coverage for treatments, services or supplies not received.
- Forging or altering a prescription.
- Doctor Shopping to obtain unnecessary prescription medications or durable medical equipment and then selling these items for a profit.
Types of Provider Fraud:
Providers: Includes physicians, dentists, pharmacists, home care providers, mental health providers, durable medical equipment suppliers, ambulance companies, medical transportation companies, hospitals nursing homes, and day care providers.
Example:
- Billing for nonexistent or unnecessary medical services, such as x-rays, laboratory tests or drugs that were never dispensed.
- Billing for more expensive products or labor intensive services than were provided.
- Paying kickbacks or providing gifts and other incentives to third parties in exchange for business or referrals to a particular doctor or hospital.
- Inflating of claimed mileage by transportation companies in order to receive greater reimbursement.
- Billing Medicaid for transportation to non-Medicaid services.
- Billing an insurance carrier or patient for the cost of a name brand prescription when a lower costing generic substitute or an over-the-counter drug was instead supplied.
- Deliberately applying for duplicate reimbursement – double billing.
- Billing for more days in a hospital or nursing home than the patient actually stayed.
- Billing services for patients who have died.
- Billing related services separately to charge a higher amount than if services were combined and billed as one service.
- Billing for used items as new items by durable medical equipment companies.
- Continuing to send recipients medical supplies when it is no longer medically necessary.
The team welcomes tips from private citizens as well as employees or colleagues who work with providers who cheat Medicaid or other public assistance programs.
How to Contact Us to Report Fraud and Abuse
Fraud and abuse of public programs affect all of us.
Everyone can take responsibility for reporting suspected fraud and abuse.
If you have reason to believe that someone is abusing Medicaid or another public assistance program, you should report it.
Again, if you prefer, you can submit your complaint anonymously and the source of all fraud and abuse complaints are kept strictly confidential.
There are several ways you can report fraud and abuse of our taxpayer dollars:
Download, print, and submit a complaint form via mail to:
Warren County Social Services
Investigations Unit
1340 State Rt. 9
Lake George, NY 12845
To make a complaint or report via phone:
Contact the Department of Social Services at (518) 761-6519
The Warren County Sheriff's Office (518) 743-2576
The Warren County District Attorney's Office (518) 761-6405
IF YOU KNOW SOMETHING, SAY SOMETHING!
