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What is fraud?Stop Fraud logo. dhcs.ca.gov/fraud, 1-800-822-6222,

Back to Stop Medi-Cal Fraud

 

The different types of Medi-Cal fraud costs CA taxpayers a lot of money.
Here is how you can help: make sure you know the types of fraud and call 1-800-822-6222 if you suspect something.

Beneficiary / Recipient

Most Medi-Cal beneficiaries are honest people who need quality health care. However, there are people who commit fraud or become involved in fraudulent schemes. The following are some types of possible beneficiary Medi-Cal fraud:

 

Recipient Exceeds Income or Asset Requirement: Occasions where a beneficiary does not report income or assets to their county worker.

 

Identity Theft:  Someone using another person's personal information to get Medi-Cal benefits. Sometimes the person whose identity was stolen is not aware until they begin to receive mail from the Medi-Cal program.

Provider

Most Medi-Cal providers are honest in their billing practices and provide quality health care to their patients. However, a relatively small number of providers commit fraud directly or become involved in fraudulent schemes. The following are some types of known Medi-Cal provider fraud:

 

Capping: When an individual recruits and pays patients money or offers gifts in exchange to participate in the Medi-Cal program. It is also illegal for an individual to receive payment or gifts to participate in the Medi-Cal program.

Balance Billing: A provider charging a Medi-Cal beneficiary for the difference between the Medi-Cal reimbursement rate and the customary charge for the service.

Provider Illegally Billing Medi-Cal:  

  • Providers ordering unnecessary lab tests

  • Dentists performing unnecessary teeth extractions on both adults and children 

  • Medical supply companies billing for equipment and products that were neither ordered nor delivered

In-Home Supportive Services (IHSS)

Most Medi-Cal recipients and providers who are in the IHSS program are honest in their practices. For many recipients, providers offer needed assistance with their daily living.  However, there some providers as well as recipients who may violate the IHSS rules and commit fraud. The following are different types of IHSS fraud:

IHSS Beneficiary:

  •  An IHSS beneficiary who does not really need services
  •  An IHSS beneficiary who demands any portion of the provider's check

 

IHSS Provider:

  • A provider is not doing the work but is getting paid. Some examples are: a provider living too far away from the beneficiary to provide the services or a provider billing for services while the beneficiary is hospitalized or out of the country.
  • A provider is forging the beneficiary's name on the IHSS timesheet. 

 

Report Med-Cal Fraud

Last modified on: 1/5/2016 3:26 PM