Florida Department Of Banking And Finance
QUESTION & COMPLAINT HOTLINES
Get Lean Line1-800-GET LEAN answers calls from 8:30 a.m. to 4:30 p.m., about waste, fraud and abuse in state government, and accepts suggestions on how the state can save money. You can leave a message during non-working hours. Callers can remain anonymous. Names are kept confidential, when given. Banking: 850-410-9111
Office of Financial Institutions and Regulation Consumer Hotline1-800-848-3792 takes questions and complaints from 8:30 a.m. to 4:30 p.m., Monday thru Friday on businesses regulated by the Divisions of Banking, Finance, and Securities, and on matters of investigatory interest to the Office of Financial Investigations.
Funeral & Cemetary Hotline1-800-323-2627 Takes questions and complaints about regulation of cemeteries in the State or pre-need requirements.
Note: Hearing impaired citizens can call the departments TDD line at 850-410-9700.
Division of Financial Investigations101 East Gaines Street, Suite 516Tallahassee, FL 32399-0350Toll Free: 800-848-3792 Phone: 850-410-9275
Florida Division of Insurance Fraudhttp://www.myfloridacfo.com/fraud/101 East Gaines Street, Suite 516Tallahassee, FL 32399-0350Toll Free: 800-848-3792 Phone: 850-410-9275
Internet Crime Complaint Center
Report Medicaid And Medicare Fraud Here
Are you a Florida healthcare professional that knows about Medicare Fraud? Help stop government waste and abuse, and get rewarded for your efforts. Our attorneys have significant experience representing healthcare industry whisteblowers. Complete the secure form on this page or call 1-800-934-2921 for a free no obligation consultation with a lawyer. During these days of service cuts and budget deficits, it is more important than ever to help stamp out the fraud that plagues government healthcare programs. Submit your report to the Florida Medicare Fraud Reporting Center today.
What Are Medicare And Medicaid
Medicare and Medicaid are public healthcare programs created in 1965 by President Lyndon Johnson. Both are funded by taxpayers, but there are some slight differences between the two.
Medicare is overseen exclusively by the federal government. It is designed to provide health insurance for the elderly and people with disabilities. Only individuals who have contributed to Medicare through payroll tax deductions may receive benefits.
Medicaid is a federal assistance program designed to provide free health services to low-income individuals. The federal government oversees the program, but each state must implement and manage Medicaid locally. It is a means-tested program, meaning applicants must demonstrate their income is below a certain threshold in order to qualify.
Recommended Reading: What Does Share Of Cost Mean For Medicaid
What Fraud Looks Like
Most providers who commit Medicaid fraud fall into one or more of these categories:
- billing for patients who did not really receive services,
- billing for a service and/or equipment that wasnt provided,
- billing for items and services that the patient no longer needs,
- overcharging for equipment or services,
- concealing ownership or associations in a related company,
- paying a kickback in exchange for a referral for medical services or equipment,
- billing more than once for the same service,
- using false credentials such as diplomas, licenses or certifications, or
- ordering tests or prescriptions that the patient does not need.
What Documents Do I Need To Report Medicare Fraud
If youre reporting Medicare fraud, its helpful to have some of your information ready.
- Medicare number
- Information about the service that was supposedly provided
- and the reason you think fraud was committed
If a reported Medicare fraud leads to the recovery of funds, Medicare may provide a reward. If you or someone you know suspects fraud, waste, or abuse, report it immediately.
The Center for Medicare and Medicaid Services states that Medicare fraud is:
- Intentionally billing Medicare for a service not provided
- Billing Medicare at a higher rate
- If a provider pays for referrals of Medicare beneficiaries
Medicare fraud is severe its not human error, its highly illegal, and it involves doctors or beneficiaries abusing the system for their own benefit. Report Medicare fraud as soon as possible.
Recommended Reading: What Are The Requirements For Medicaid In Colorado
Apd Currently Performs Reviews Of Medicaid Claims As Follows:
- A regular review of paid Medicaid claims for individuals served by APD is conducted by the agency. APD utilizes more than 60 separate review procedures relative to processing Medicaid claims. Based on these reviews APD, in conjunction with AHCA and the Attorney General’s Office, carries out or oversees Medicaid recoupment for improper claims.
- For the APD private provider sector, performance of Medicaid billing and claims audits is conducted as part of a fiscal review by an agency contractor. Approximately 170 onsite provider reviews are conducted each year. Where Medicaid claims without adequate supporting documentation are identified, audit-based recoupments of funds are taken in conjunction with AHCA.
- Upon receiving reports of possible Medicaid fraud or abuse, APD auditors conduct an initial review. Auditors may refer allegations to the APD Inspector General, to AHCA Medicaid Program Integrity or to the Attorney General’s Medicaid Fraud Control Unit.
- For the APD services, APD conducts routine reviews of documentation supporting Medicaid claims. The APD Inspector General’s Office also conducts program and facility audits under its oversight authority.
How To Report Fraud
You can help protect your tax dollars by reporting suspected fraud by phone, through the Internet or by regular mail. You can do this without giving your name, but if you agree to give your name and other contact information, that helps the investigators to obtain future information.
Before you make a report, try to get as much information as possible, including:
- the name of the person you suspect of committing fraud. This might be a person receiving medical benefits or a health care professional hospital, nursing home, or other facility that provides Medicaid services
- the Medicaid ID number
- the amount of money involved, and/or
- a description of the acts that you suspect involve fraud
Also Check: How To Get Medicaid Certified
Common Examples Of Medicare/medicaid Fraud
Fraud committed by healthcare providers often takes the form of billing irregularities, such as:
- Charging for services that werent actually provided
- Charging for the performance of unnecessary tests
- Charging for unnecessary referrals
- Charging separately for services that are usually charged as a package rate, a practice better known as unbundling and
- Filing claims for reimbursement to which a claimant isnt actually entitled.
These, however, are not the only types of fraud in which healthcare providers can engage. Many Medicare/Medicaid fraud claims, for instance, involve allegations of offering, soliciting, or paying for referrals for medical services, a practice also known as taking kickbacks. Other common forms of Medicare/Medicaid fraud include:
- Illegally pricing drugs
- Failing to comply with best pricing in the Medicaid program
- Improperly marketing drugs
- Overcharging at pharmacies and
- Creating or using false records or statements to conceal or decrease an obligation to pay the federal government.
While there are a number of federal task force teams that have been charged with preventing Medicare/Medicaid fraud, this type of fraudulent activity continues to occur at an alarming rate across the country. The federal government does, however, also allow others to report insider knowledge of Medicare/Medicaid fraud and even offers rewards for successful claims.
Filing A Whistleblower Claim
The False Claims Act allows anyone who directly or indirectly causes fraud in government healthcare programs to sue the wrongdoer on behalf of the U.S. These are known as qui tam actions and must be filed under seal in federal district court. This means that the complaint and the evidence it contains will be kept confidential, at least until the seal is lifted. During this time, the government will investigate the allegations and the evidence submitted by the whistleblower. If the government decides to pursue a lawsuit based on this information, the whistleblower could be entitled to between 15 and 30 percent of any award it recovers. Medicare/Medicaid fraud is often widespread and involves thousands of patients and beneficiaries, so this could result in a reward worth millions of dollars for the claimant.
You May Like: Virginia Medicaid Customer Service Phone Number
Preventing Fraud And Abuse
- Your Medicaid card and number are yours. Do not let anyone else use them.
- Do not give your Medicaid number to a stranger or in exchange for a special offer.
- Remember that Medicaid does not pay for mentoring, after-school programs, summer camps, or tutoring.
- Ask for a written description of the services offered to you.
- Do not agree to services that you do not think you or your child need.
- Do not sign a blank form.
- Write down the names of the people that provide your services, the agencies they work for, and the dates the services are provided.
Florida Medicare/medicaid Fraud Lawyer
Medicare and Medicaid-related fraud is a type of fraud in which healthcare providers use illegal and deceptive practices to obtain unfairly high payouts from government funded healthcare programs. Medicare and Medicaid fraud can be committed by a wide range of entities and individuals, including medical professionals, patients, suppliers of medical equipment, and healthcare facilities. Fortunately, those who commit fraud against federal programs can be held liable for their actions and individuals who notify the government of the unlawful activities could also be entitled to a reward. To learn more about the claim filing process, please call a Florida Medicare/Medicaid fraud lawyer today.
Read Also: Texas Medicaid Provider Enrollment Portal
Can You Go To Jail For Medicaid Fraud
All of these activities are against the law, and there are potentially serious consequences for engaging in any of them. The minimum consequence for fraudulent claims may be the denial of payment. Medicaid may also suspend or revoke authorization to bill for a provider suspected of fraud, and it may sue in a civil court to recover fraudulently claimed benefits. Serious cases of suspected fraud may also be referred to a prosecutors office for criminal charges, which may result in prison time for convicted fraud participants.
How To Report Medicare Fraud
You can call the Medicare fraud hotline or report the fraud by contacting one of these organizations:
- Department of Health and Human Services Office of Inspector General Medicare fraud hotline at 1-800-HHS-TIPS
- Contact the HHS by mail at HHS Tips Hotline, PO Box 23489, Washington, DC 20026-348
- Centers for Medicare and Medicaid Services at 1-800-MEDICARE
- Contact CMS by mail at Medicare Beneficiary Contact Center, PO Box 39, Lawrence, KS 66044
- You can report it by calling the CMS report hotline or submit the information online.
Read Also: How To Cancel Medicaid In Virginia
What You Do To Prevent Fraud
- Do not give your Medicaid card number to anyone except your doctor, hospital or other health care provider
- Do not ask your doctor or other medical provider for medical care you do not need.
- Be suspicious if you are offered free screenings or tests in exchange for your Medicaid card number.
- Ask questions if someone wants you to have services or treatments that you feel you do not need. If necessary, get a second opinion from another health care provider.
- Do not accept money or gifts from anyone who offers to buy medicine that you have received through Medicaid.
Those who report fraud may be entitled to a reward if they report a criminal case that results in a fine, penalty or forfeiture of property. To find out more, call the Attorney General at 1-866-966-7226. FS 409.9203 Rewards for reporting Medicaid fraud
112.3187 Adverse action against employee for disclosing information of specified nature prohibited employee remedy and relief – may be cited as the “Whistle-blower’s Act.”
While committing significant resources to protect the publics interest, the Attorney Generals Office will always welcome the assistance of the citizens in fighting against health care fraud. Under Floridas False Claims Act, persons who blow the whistle on Medicaid Fraud are entitled to share in any funds recovered by the state. Please visit the Attorney General’s Medicaid Fraud Control Unit page to report your suspicions of fraud or abuse.
Additional Information For Members
To report suspected fraud and/or abuse in Florida Medicaid, call the Consumer Complaint Hotline toll free at 1-888-419-3456 or complete a Medicaid Fraud and Abuse Complaint Form. You may also report suspected fraud or abuse by contacting the Florida Attorney Generals office at 1-866-966-7226.
If you have questions, please call Member Services toll-free at 1-855-355-9800 .
Also Check: Lift Chairs Covered By Medicaid
Cases Of Medicaid Provider Fraud
As stated above in the Cases of Medicaid Recipient Fraud, provider fraud also comes in several different flavors. And again, is why both users and suppliers must work together to identify any fraudulent activity perpetrated by Medicaid suppliers.
Ways to assist the Office of Medicaid Management in identifying fraudulent activity include keeping records on the following items:
- When you received service from a Medicaid professional.
- Where the service took place.
- Who the professional was who provided care to you.
- Which services were given during the visit.
- Any additional services ordered by the provider.
Any services billed that werent actually provided are considered fraud and need to be reported.
Examples of Medicaid supplier fraud include:
How To Report Medicaid Fraud
If you know about or suspect irregularities in Medicaid billing or other practices, you may want to tell someone, but you might also be unsure of how to report Medicaid fraud in a way that will stop the abuse. At a federal level, the Department of Health and Human Services coordinates fraud and abuse reporting among the states. The department maintains an online directory of state-level MFCUs. Each entry on the directory has a contact name, mailing and email address, and a phone number you can call to report suspected cases of fraud. You may submit your report anonymously in all 50 states.
Read Also: Apply For Pregnancy Medicaid Arkansas
Florida Fbi Field Offices Mortgage Fraud
White Collar Crime Supervisor7820 Arlington Expressway, Suite 200Jacksonville, FL 32211-7499
North Miami Beach, FL 33169-6508Phone: 305-944-9101
500 Zack Street, Room 610, FOBTampa, FL 33602-3917
Charles E. Bennett Federal Building400 W. Bay Street, Suite 1015Jacksonville, FL 32202
3751 Maguire Boulevard, Room 270Orlando, FL 32803-3032
500 Zack Street, Suite 402Tampa, FL 33602
Providers For Florida Healthy Kids
CCPs compliance program is essential to prevent, detect and correct non-compliance as well as fraud, waste and abuse. Providers of services to CCP members are a vital component of the program.
CCP provides a Provider Compliance Training to assist physicians and providers in meeting compliance program requirements, including fraud, waste and abuse.
CCP Provider Compliance Training:
Suspected instances of Fraud, Waste and Abuse can be reported directly to the Community Care Plan Compliance Officer at 954-622-3482 or via email at or . Anonymous reports can be made to CCP by calling or going to www.lighthouse-services.com/ccpcares.
To direct report suspected fraud, waste, or abuse in the Medicaid Program, the Healthy Kids Program or any other CCP program, please use one of the following avenues:
- Florida Attorney Generals Office: or
- Report Insurance Fraud to Floridas Chief Financial Officer at or
- Department of Health and Human Services Office of Inspector General Hotline:
Recommended Reading: What Is Medicaid Who Typically Qualifies
Health Care Fraud And Abuse Affects All Of Us By Increasing The Cost Of Health Care Services And Health Coverage Premiums
To combat fraud and abuse, Florida Blues Special Investigation Unit conducts investigations when a fraudulent insurance act is suspected or has been committed. These acts range from billing for a service that was never rendered to duplicate submission of a claim for the same service and misrepresenting the services provided.
If you believe you have information relating to health care fraud and/or abuse, file an Insurance Fraud and Abuse report. We review all reports and may contact you if additional information is needed. Allegations that show sufficient evidence to support possible fraudulent activity may be assigned for investigation.
Reports can be completed and submitted online, or you may download a form in PDF format and return it to us by U.S. mail. If you are unable to complete one of the forms below, you may call the Special Investigation Unit.
Billing For Unnecessary Services And/or Supplies
Billing for unnecessary services is a more subtle form of fraud. In this case, a doctor could charge for expensive consultations that were not necessary. Another example would be a transport company billing for a wheelchair rider at the higher gurney transport rate. It can be difficult to detect this type of Medicaid fraud, since many of the decisions to provide more expensive care are subjective and require review by an equally medically qualified investigator.
Read Also: Rehab Centers In Florida That Accept Medicaid
What Is Medicare Fraud
Medicare Fraud is a crime. Those responsible face severe financial penalties and incarceration. Doctors, Insurers, Hospitals, Hospice, Rehabilitation Clinics and Pharmaceutical companies have all been found guilty of Medicare, Medicaid and Tricare fraud.
Healthcare Fraud Fact Patterns: Exposed by whistleblowers, the following conduct constitutes the most popular ways healthcare professionals are cheating taxpayers:
Phantom billing schemes, Upcoding & Unbundling, Illegal Kickbacks, False Billing for Non-Covered Services, Misrepresenting Information, Providing Unnecessary Care to Inflate Reimbursements, and a variety of Prescription Scams.
Who reports Medicare Fraud?
Some people think patients are the only people reporting Medicare fraud.
Patients should inform when something is wrong but medical professionals are in the best position to have knowledge of and report Medicare Fraud. Doctors, Specialists, Administrators, Nurses, Pharmacist or any medical employee can report.
Working in the healthcare system provides them an insiders knowledge of the right and wrong way treat patients and seek reimbursements for care.
Their access and knowledge of fraud puts them in the ideal position to report on an uncovered pattern of abuse. When abuse, fraud or misuse fact patterns emerge they have an ethical responsibility to report it and help stop the illegal conduct from continuing.
What Is The Stark Law
The Stark Law isnt a law, but a group of federal laws designed to prevent the practice of physician self-referral. Stark Law is defined by 42 U.S.C. 1395nn. Physician self-referral occurs when a doctor sends a Medicare patient to receive services from a medical facility in which the doctor has a financial interest. Financial interest includes ownership, investment, or a structured compensation arrangement.
Physicians who violate Stark Law face crushing civil penalties. Each violation carries a $15,000 civil monetary penalty per knowing violation. The penalty climbs to $100,000 per violation that was knowingly committed to circumvent the law.
Recommended Reading: Dentist Who Accept Medicaid For Braces
