The Attorney General’s Medicaid Fraud Control Unit (MFCU) investigates and prosecutes Medicaid fraud by health care providers and the abuse, neglect or financial exploitation of patients in any facility that accepts Medicaid funds.
Medicaid is a government program that provides services and health care to low income and medically needy people. Many of the people served by the Medicaid program are vulnerable adults – low income senior citizens and mentally, physically or developmentally disabled adults.
The Attorney General’s Medicaid Fraud Control Unit investigates complaints of:
When any provider of health care has defrauded the state Medicaid system. Providers include hospitals, nursing homes, pharmacies, laboratories, doctors, dentists and anyone else who is paid by Medicaid for a health care service.
Fraud is intentional deception or misrepresentation which results in an unearned benefit, usually in the form of an excess payment. While health care fraud can take many forms, the most common involve billing for services not performed or billing for more expensive services than those actually provided. Other forms of fraud include billing Medicaid at a higher rate than the rate charged a patient who is covered by insurance or who pays the bill himself or herself and billing a patient or patient’s family for a service Medicaid has already paid for, even if the Medicaid payment was less than the usual charge for the service.
Medicaid patients may not suspect fraud, as they are seldom made aware of the procedures or dollar amounts billed to Medicaid.
An unscrupulous provider can generate a fraudulent Medicaid payment simply by filing a false claim with an eligible recipient’s identification number and a valid procedure code.
Medicaid patient abuse and neglect in Medicaid-funded facilities
Patient abuse: The intentional or negligent infliction of physical pain, physical injury or mental injury.
Patient neglect: Failure of a caretaker to provide food, clothing, shelter or medical care in such a manner as to jeopardize the life, health and safety of the vulnerable adult.
Patient exploitation: An action that may include the misuse of funds, property or resources of a vulnerable adult.
Misappropriation of patients' private funds
When any provider has misappropriated money belonging to a patient in a hospital, nursing home or other health care facility that receives Medicaid funds.
If you know about fraud, theft or abuse, please contact us. Even if you only have suspicions, are not sure whether we can help or have already called the police or a state agency, we would like to hear from you. You can reach us at 208-334–4100. You can also report suspected fraud, abuse or theft here.
If you or someone you know is in danger, contact local police immediately.
Additional Contact Information
To report Medicaid recipient fraud, contact the Idaho Department of Health & Welfare at 1-866-635-7515 or by e–mail at firstname.lastname@example.org.
Employers: Check the HHS OIG Exclusion Database and the Idaho Medicaid Exclusion List to make sure you are not billing Medicaid for services associated with an excluded individual. Failure to do so may result in a $10,000 civil penalty for each claim.