Health Care Fraud

Health Care Fraud Division

  • The Health Care Fraud Division (HFCD) exists to identify, prosecute, and prevent fraudulent activity by doctors, dentists, pharmacists, and other health care providers participating in the Medicaid program. Allegations of misappropriation of patient trust funds and identity theft in resident care facilities are also investigated. Taxpayer dollars provide health care to indigent patients and other recipients. It is vital that these dollars be effectively spent to help those in need. Fraud affects everyone - the recipients of care, the taxpayers who pay for it, and the overwhelming majority of providers who conscientiously provide quality care.

    Since its inception, the HCFD has obtained criminal restitution orders totaling $19,453,258.47 and civil judgments totaling $407,413,167.89. In total, the HCFD has obtained court orders and settlements requiring the return of over $426 million dollars to the Medicaid Program.

     Learn more about the Health Care Fraud Division

What does Medicare/Medicaid fraud look like?

Doctor with stethoscope in handcuffs isolated on white
    • Bill for services not provided, i.e. a chest x-ray when an x-ray was not taken.
    • Duplicate Billing occurs when a provider bills Medicaid and the recipient or private insurance for the same service.
    • Requires that the patient come back each week for the same problem or to get the same prescription when another appointment is not necessary, or a normal amount of medication could be prescribed.
    • Upcode, i.e. identify a simple office visit as an emergency office visit or a comprehensive visit.
    • Take unnecessary x-rays, blood work or perform other unnecessary services.
     View other examples

  •  A recipient of medical services should remember:

    • When a professional service is used,
    • Where the service takes place,
    • Who takes care of you,
    • What scheduled services are provided during the visit, and
    • What additional non-scheduled services are provided.

     

    If you suspect fraud, please call the Health Care Fraud Division Hotline (800) 24-ABUSE (800-242-2873), to report your concern.

  • Department of Attorney General
    Health Care Fraud Division
    P.O. Box 30218
    Lansing, MI 48909
    24-Hour Hotline: 800-24-ABUSE (800-242-2873)
    Fax: 517-241-6515 or 517-241-1029 
    (during business hours)
    Email the Health Care Fraud Division
    Medicaid Fraud Complaint Form

    		 Medicaid Recipient Fraud
    Office of Inspector General (OIG)
    Department of Health & Human Services
    Fraud Hotline: 800-222-8558
    Medicaid general information & help line:
    800-642-3195
    Medicaid card information: call your caseworker

    Center for Medicare & Medicaid Services (CMS)
    Federal OIG Fraud & Abuse Information
    HHS/OIG Hotline
    P.O. Box 23489
    Washington, DC 20026
    Phone: 800-HHS-TIPS (800-447-8477)
    Email CMS
     

    		 Social Security
    Office of Public Inquiries
    1100 West High Rise
    6401 Security Blvd.
    Baltimore, MD 21235
    Phone: 800-772-1213
    TTY: 800-325-0778
    Email Social Security

  • Patient Rights & Responsibilities

    1. A patient or resident shall not be denied appropriate care on the basis of race, religion, national origin, sex, age, handicap, marital status, sexual preference, or source of payment.
    2. An individual may obtain or inspect his/her medical records and a third party shall not be given a copy without authorization of the patient except as required by law and third party contract.
    3. A patient or resident is entitled to privacy, to the extent feasible, in treatment and caring for personal needs with consideration, respect, and full recognition of his/her dignity and individuality.
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