Reporting Suspected Wrong-doing of a NH Medicaid Provider
The mission of the Program Integrity Unit is to promote Program Integrity compliance and safeguard NH Medicaid funds to ensure access to quality services and services and foster positive health outcomes for NH Medicaid beneficiaries. The Program Integrity Unit coordinates its efforts with other DHHS departments as well as with the State of NH Office of the Attorney General Medicaid Fraud Control Unit (MFCU).
Every tip and complaint is important, and we review each one as quickly as possible. However, not every tip results in an investigation. Please note that, by statute, 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.
If you report suspected illegal activity, state whistleblower laws may protect your identity and also may protect you from an employer's retaliation or intimidation.
Provider fraud results in theft of tax payer money and reduced quality care to our members. You are encouraged to report matters involving suspected fraud and abuse.
Behaviors investigated by Program Integrity include:
- Claims for services not provided;
- Claims with missing or incorrect information;
- Claims with incorrect procedure codes;
- Claims for services that were not medically necessary;
- Claims for additional services the patient did not agree to;
- Failure to maintain appropriate medical records;
- Excessive or inappropriate referrals;
- Excessive or Inappropriate checks for eligibility;
- Inaccurate or expired credentials/qualifications; or
- Claims without first billing third party liability payers.