“Up-coding,” which is billing Medicaid for a more expensive procedure or service than was actually performed or provided. In addition, the Medicaid Fraud Control Unit is responsible for the investigation and prosecution of cases of suspected abuse/neglect and/or exploitation of vulnerable persons/...
The first three years MFCU has recovered over $660 million in taxpayer funds. As the largest unit within Attorney General Cuomo's division of criminal justice, MFCU investigates and prosecutes Medicaid fraud as well as patient abuse and neglect, and served as the federal model for the creation ...
Javier D. Diaz
according to the Florida Department of Financial Services’ Division of Public Assistance Fraud.Individual benefit fraud is investigated by the Department of Financial Services’ Division of Public Assistance Fraud. The division has 44 investigators responsible for investigating fraud in Medicaid, food stamp...
care plan, control over the delivery of those services, and hence, reimbursement forthose services may fall to either the LEA or the health plan, depending on the termsof any contractual relationship between the LEA and the MCO. When an LEA is notin the “provider network” of the MCO, ...
The Centers for Medicare & Medicaid Services (CMS) is the division of the Department of Health & Human Services (HHS) responsible for administering Medicare, Medicaid, and the State Children’s Health Insurance Program (CHIP). CMS also is responsible for administering the private health insurance ...