Billing for services not rendered: A provider bills Medicaid for a procedure or service that was not actually provided.
Double Billing: A provider bills Medicaid twice for the same procedure or service.
Billing for unnecessary services: A provider misrepresents the diagnosis and symptoms on patient records and billing invoices in order to obtain payment for unnecessary services.
Drug Substitution: A pharmacist fills a recipient's prescription with a generic drug, but bills Medicaid for a higher cost brand name drug.
Kickbacks: A provider offers or pays a kickback to induce someone to refer Medicaid recipients to that provider as patients or clients. Examples of kickbacks include cash, vacations, and gifts.
Supplemental Charges: A provider charges a Medicaid recipient for a service which is covered by Medicaid and should be billed to Medicaid, and then charges the recipient the difference between the provider's usual fee and what Medicaid pays.
Inflating the Usual and Customary Charges: A provider charges Medicaid more than their usual and customary charge for the same product or service billed to other insurers and the public. A provider might inflate the cost of the procedure, service or goods provided.
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