Medicaid Fraud

What is Medicaid?

Medicaid is a state and federal program that provides health care benefits for qualifying low-income adults, children and persons with certain disabilities. In Oregon, the Medicaid program is called the Oregon Health Plan and is administered by the Oregon Heath Authority.

What is Medicaid Fraud?

There are many types of Medicaid provider billing fraud. Fraud can include providers billing Medicaid for goods and services that were never provided, were of lower quality or were unnecessary.

The Oregon Department of Justice’s Medicaid Fraud Control Unit (MFCU) 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 can take years to investigate, but bring millions of dollars back to the state Medicaid program.

Medicaid recipient fraud can include falsifying information on applications in order to receive benefits, which would be investigated by the DHS Fraud Unit. The MFCU does not investigate individuals who receive services as part of the Medicaid program.

Medicaid vs. Medicare

Although they sound similar, Medicaid and Medicare are not the same thing.

Medicare is a federally funded 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, we do not investigate or prosecute Medicare fraud. For more information about Medicare fraud, please visit medicare.gov » or call 1-800-MEDICARE.

How to Spot Medicaid Fraud

Medicaid recipients, or their family members and people who work for them, should closely monitor medical billing statements. Keep a lookout for unusual activity, such as:

  • charges for services that were never performed, or for goods you never received.
  • billing for the same thing twice.
  • services that were not ordered by your doctor.
  • providers who recommend/perform unnecessary services or tests.

Medicaid fraud may also include:

  • a patient whose medication is missing.
  • unexplained cuts, black eyes, bruises or burns.

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 fraud allegation report online »
  • Call the DHS Fraud Hotline at 1-888-372-8301 (8:00 am to 5:00 pm Pacific Time)
  • Fax your written complaint to 503-373-1525. Address your fax to ATTN: HOTLINE
  • Mail your written complaint to:

Investigations Unit
P.O. Box 14150
Salem, OR 97309

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

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