Library: Policy

317:35-13-6. Fraud

Revised 5-26-03

     Federal and State laws make it unlawful for persons to make any false statement or misrepresent facts to receive benefits or payments under the Medicaid Program.  The worker, employed by the Department of Human Services, is responsible for ensuring each individual who applies for Medicaid is advised of the responsibilities to provide correct information and to report changes in circumstances which may affect his/her eligibility for Medicaid benefits.  As each new provider or supplier of medical services is approved, a letter is mailed to him/her from the OHCA advising of the penalties for misrepresentation of fact on claims for Medicaid benefits.  When a local office obtains information indicating possible fraud or abuse by a provider, supplier of medical services, or a recipient, a memorandum explaining the circumstances is forwarded to the OHCA Legal Division.  This office has the responsibility for any required action on this type of complaint and appropriate referral of the complaint.