Medicaid is a health care program that that serves qualifying low-income adults, children and persons with certain disabilities. Medicaid fraud is purposely billing the government for services that were never provided, unnecessary, or otherwise leveraging the Medicaid program in order to make a profit. DOJ’s Medicaid Fraud Control Unit aggressively investigates and prosecutes billing fraud committed by Medicaid providers and abuse and neglect of residents who live in Medicaid-funded facilities. These complex cases may take several years to investigate, but bring millions of dollars back to the state Medicaid program.

Medicaid vs. Medicare. Although they sound similar, Medicaid and Medicare are not the same thing. In Oregon, Medicaid funded programs, such as the Oregon Health Plan, are administered by state agencies and receive both state and federal funding. Medicare is a federal health care program that primarily serves U.S. citizens who are age 65 or older, or who are permanently disabled and cannot work. Because Medicare is not a state funded program, DOJ does not investigate or prosecute Medicare fraud. For more information about Medicare fraud, please visit www.stopmedicarefraud.gov or call 1-800-MEDICARE.

How to spot Medicaid fraud. Medicaid recipients, or their family members and people who work them, should closely monitor medical billing statements if they suspect there is fraud. Keep a look out for unusual activity such as:

• “Phantom” charges for services that were never performed
• Billing for services that are more expensive that those actually provided
• Duplicate charges for the same service
• Providers who recommend/perform unnecessary services or tests

Medicaid fraud may also include:

• Stealing money from Medicaid patients, such as residents who live in Medicaid funded nursing homes
• Illegal kickback schemes in which one provider pays another in exchange for referrals or other business

Report Medicaid fraud. If you suspect Medicaid fraud may be occurring in Oregon, please file a report by doing one of the following:

• File a report online
• Call the DHS Fraud Hotline at 1-888-372-8301. You may talk to the Hotline Coordinator or leave a message during regular business hours (8:00 am to 5:00 pm Pacific Time)
• Fax your written complaint 503-373-1525. Please address your fax to ATTN: HOTLINE
• Mail your written complaint to: Investigations Unit, PO BOX 14150, Salem, OR 97309

Please use one method as all complaints are given to and processed by the Client Fraud Hotline Coordinator.

You can also report Medicaid fraud to the U.S. Department of Health and Human Services.