What is Fraud and Abuse?
Fraud and abuse is when a person(s) cheats or is dishonest and receives a benefit as a result. Examples of fraud or abuse by a client of DHHS include:
- Doesn’t report all income when applying for benefits;
- Doesn’t report other insurance when applying for Medicaid;
- Allows someone else to use his or her benefits card;
- Allows another client to use their Medicaid card; or
- Gets services that are not necessary or are from more than one provider.
Examples of fraud or abuse by a provider for DHHS include:
- Inaccurate credentials;
- Repeated claims for services not provided;
- Repeated claims with missing or incorrect information;
- Repeated claims with incorrect procedure codes;
- Repeated claims that have already been denied;
- Repeated claims for services that were not medically necessary;
- Repeated claims for additional services the patient did not agree to;
- Failure to maintain appropriate medical records;
- Excessive or inappropriate referrals;
- Over-prescribing or mis-prescribing products or services; or
- Repeated claims without first billing third party liability payers.
Someone who commits fraud or abuse is stealing taxpayer money. You are encouraged to report matters involving fraud and abuse. If you want to report fraud or abuse, you can remain anonymous; however, sometimes staff may need to contact you for additional information, but your name will not be shared with anyone who is being investigated.
How to Report Fraud and Abuse Of the Medicaid Program
Office of the Attorney General
Medicaid/Healthcare Fraud Unit
33 Capitol Street
Concord, NH 03301
Or call: (603) 271-1246
Or fax: (603) 271-2110
How to Report Fraud and Abuse of All Other Programs
Department of Health and Human Services
Office of Improvement & Integrity, Special Investigations
129 Pleasant St., Brown Building
Concord, NH 03301
Or call: 603-271-9258
Or fax: 603-271-4472
Visit the Special Investigations page.