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Fraud and Other Recoveries

Medicaid fraud is a deliberate withholding or hiding of information or giving false information to get Medicaid or FAMIS Plus benefits. Medicaid fraud also occurs when a provider bills Medicaid for services that were not delivered to a Medicaid recipient, or if a recipient shares his/her Medicaid number with another person to get medical care. Anyone convicted of Medicaid fraud in a criminal court must repay the Medicaid program for all losses (paid claims and managed care premiums) and cannot get Medicaid for one year after conviction. In addition, the sentence could include a fine up to $25,000 and/or up to 20 years in prison. You may also have to repay the Medicaid program for any claims and managed care premiums paid during periods you were not eligible for Medicaid due to acts not considered criminal. Fraud and abuse should be reported to your local Department of Social Services or to the Department of Medical Assistance Services Recipient Audit Unit at (804) 786-0156.

This information can also be found in the Medicaid Manual.

If you suspect fraud and abuse related to any Medicaid services, you may contact our Compliance Officer at 888.827.2884 or via email at ProviderIssues@kepro.com.

Please also refer to the following link for additional information: Centers for Medicare & Medicaid Services- Medicaid Fraud Detection for Investigation Program