Report Suspected Medicaid Provider Fraud
Information and guidance regarding what to do when suspecting a Medicaid provider of fraudulent practices
Federal regulations require States to investigate any potential Medicaid provider wrong billing or fraud. (42 CFR 455.14).
Provider fraud and abuse affects all of us and can result in harm to people, if not reported. We need your help to ensure our Medicaid program is reliable and effective. If you suspect that a Medicaid provider is billing Medicaid incorrectly or committing fraud, please contact the Program Integrity Unit.
Providers; if you have an audit done or have questions, what should you do?
Providers can also report issues or ask questions to the Program Integrity Unit at the contact information below. If providers perform “self-audits” or have audits done in which funds should be returned to the Medicaid program, please contact the Program Integrity Unit utilizing the contact information below.
We review each tip or complaint as quickly as possible. Please note that, by law, the Unit’s work is confidential and therefore we generally cannot provide you with information about or comment on any action undertaken regarding your complaint or any other complaint.
A provider submits a bill for payment in which:
- The service was not provided;
- There is missing or incorrect information being billed;
- The incorrect procedure is billed;
- The service is not medically necessary;
- You or a patient did not agree to the service performed;
- The provider did not first bill a primary insurance or Medicare.
- A provider prescribes medications for people who are not patients or have not been seen by a doctor;
- A provider provides services without proper or with expired credentials/qualifications;
- A provider makes excessive or inappropriate referrals;
- A provider fails to maintain appropriate medical records; or
- A provider inappropriately checks for Medicaid member eligibility.
Important Message About Using Email
ProgramIntegrity@dhhs.nh.gov is not a secure e-mail. Please do not send Medicaid member’s personally identifiable information (PII) or Medicaid member private health information (PHI) through this e-mail. You can send a provider name and address with your complaint. If you need to send Medicaid member information, please write, phone, or fax your complaint using the contact information above.