Self-Pay Revenue Management

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How to Prevent and Deal with Medicaid Fraud

February 4, 2019 - 5:35 PM



“In 2015, improper payments alone—which include things like payment for non-covered services or for services that were billed but not provided—totaled more than $29 billion” according to the Government Accountability Office. This number has gone up exponentially since then. Medicaid fraud happens when a con artist steal Medicaid numbers and other personal information in order to receive healthcare at no costs. Unfortunately, some providers and billers also commit fraud when they purposefully change dates or add services. There are also so many other examples of Medicaid fraud that can be located on the National Conference of State Legislatures’ website. The government has taken many precautions to make sure Medicaid fraud stays at a minimum, but what can a health clinic do to prevent fraud?

Preventing Fraud

Educate Patients

Reminding your patients to double-check the charges and service dates is one way to spot fraud. Educating patients on the importance of not sharing signatures or personal/medical information is another way to stop fraud before it even starts. Con artists gaining patient information is one of the biggest mistakes that leads to fraud. If patients understand the importance of keeping their information safe and double-checking dates and service information, their information is kept more safely.

Educate Staff

Training health clinic staff and other providers on the consequences of provider fraud can prevent the staff from wanting even thinking about committing fraud. Explaining that a merely second-degree felony could earn the wrongdoer up to 15 years in prison, depending on what state you are in allows employees and health care providers to understand the severity of the issue. Other punishments like fines, restitution, and probation are also important to explain. Including all types of actions that are considered fraud will prevent ignorant staff from committing fraud without even knowing how serious the issue is. Informing employees of rewards for whistle blowers create an incentive to report any fraud they might come into contact with. This is why teaching employees how to report fraud is a great so important.


Auditing Medicaid reimbursements and bills with actual services provided is a way to catch fraud before it effects your health center negatively. Also, if employees know random and scheduled audits, they are less likely to want to commit fraud for fear of getting caught.

Dealing with Fraud

Reporting Fraud

Reporting fraud is very simple. There is a Medicaid Fraud Hotline available to anyone within your center who sees fraud in action. Contacting attorneys who take fraudulent cases is another way to report Medicaid fraud. As stated before, whistle-blowers may be compensated for reaching out and reporting fraudulent activities.

Punishing Wrongdoers

Depending on if the government gets involved with the situation, punishing the employee who committed fraud is necessary. Depending on what your employee handbook, clinic values, and leadership, punishment can be forced sabbatical, community service, or even termination. Punishing employees who commit fraud sets a precedent and demonstrates to other employees that Medicaid fraud is never tolerated within our organization.

For more information about how you can get the most from Medicaid visit


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