Program Integrity investigates activities relating to the prevention, detection and investigation of alleged provider and beneficiary fraud and/or abuse in the Medicaid program.
Every dollar lost to the misuse of Medicaid benefits, is one less dollar available to fund programs providing essential medical services for vulnerable Mississippians. If we don’t work together to help stop fraud and abuse, the system might not be available for those whom the program was created to help.
- Report fraud and abuse online by submitting a fraud and abuse complaint form
Types of Provider Fraud and Abuse
Medicaid providers (e.g., doctor, dentist, counselor, etc.) should be referred to the Office of Program Integrity for suspicion of abuse and fraud such as:
- Billing for services not rendered
- Billing for services not medically necessary
- “Upcoding” or inappropriate billing that results in a loss to the Medicaid program
- Inappropriate or lack of documentation to support services billed
- Quality of care issues that fail to meet professionally recognized health care standards
- Falsifying certificates of medical necessity, plans of treatment, and medical records to justify payment
- Soliciting or receiving kickbacks
- Violating Medicaid policies, procedures, rules, regulations, and/or statutes
Types of Beneficiary Fraud and Abuse
Medicaid beneficiaries should be referred to the Office of Program Integrity for review if there is suspicion of:
- Excessive use or overuse of Medicaid
- Using another’s Medicaid Identification card
- Lending, altering or duplicating a Medicaid ID
- Providing incorrect eligibility or false information to a provider to obtain treatment
- Simultaneously receiving benefits in Mississippi and another state
- Knowingly assisting providers in rendering services to defraud the Medicaid program
- Prescription fraud
Thank you for your support to fulfill our mission, by ensuring that Medicaid dollars are used to provide quality health coverage for those who are eligible to receive services.
How to Report Fraud or Abuse
You can report fraud or abuse by calling or completing an online form:
Fraud and abuse complaint form
Medicaid Program Integrity Education
The Center for Program Integrity provides educational resources to educate providers, beneficiaries and other stakeholders in promoting best practices and awareness of Medicaid fraud, waste and abuse.
Medicaid Provider Integrity Education (MPIE) materials are applicable to providers, beneficiaries, and state managed care plans. MPIE materials include topic-based information in an easy-to-read format that aid in furthering education efforts of providers, beneficiaries and other Medicaid stakeholders. The information provided is intended to further the education efforts of Medicaid Program Integrity Education, assist providers with being in compliance with their billing and assist in the fight against fraud, waste and abuse.
To access educational booklets, fact sheets and provider checklist resources and tools which promote efforts to prevent Medicaid fraud, waste and improper payments, visit the Medicaid Program Integrity Education page on the Centers for Medicare and Medicaid Services website.