Fraud and Abuse

Medicaid Specific

The DMAS Fraud and Abuse Referral Hotline is available for concerned citizens to report allegations related to inappropriate use of Medicaid benefits. The Program Integrity Division at DMAS administers the DMAS Fraud & Abuse Referral Hotline and ensures that all suspected cases of Medicaid fraud and abuse are appropriately investigated. Examples of the types of complaints to be reported related to the Medicaid program operations or processes are as follows:

• Billing for goods and/or services that were not provided or inaccurate billing of goods/services
• Inappropriate services rendered by providers
• Failing to comply with DMAS (or DMAS contracted entity) documentation Requirements
• Utilizing non-qualified staff for services
• Up Coding (i.e. inflating for charges/services provided)
• Misrepresentation or withholding of information
• Uncompensated transfer of property
• Unreported resources or income
• Fraudulent household composition
• Drug Diversion
• Illegal Use of Medicaid Cards (i.e. Card Sharing)
• Inaccurate reporting of household circumstances or resources
• Fraudulent Medicaid application practices

There are two methods for reporting these types of allegations listed above:

• DMAS Fraud & Abuse Referral Hotline at 1-866-486-1971
• Email address: recipientfraud@dmas.virginia.gov

Other State Fraud and Abuse

Unrelated to Medicaid program operations or processes, a hotline exists to provide citizens the capability to report other types of fraud, waste and abuse related to the agency of DMAS. These complaints are taken very seriously, and the information a caller provides is screened by the Office of the State Inspector General (OSIG) to determine if it is sufficient and significant enough to conduct an effective investigation. It is important to provide specific details in order to conduct an investigation. Examples of these types of complaints are as follows:

• Embezzlement or other fraudulent conduct
• Contract fraud
• Inappropriate use of state funds
• Falsification of documents
• Abuse of state owned property, including personal use

OSIG administers the Hotline related to these types of allegations and will conduct and coordinate an investigation in partnership with appropriate individuals at the state agency. These types of allegations should be reported to the Office of the State Inspector General using the link listed below. You can find more information on the reporting process using the OSIG State Fraud and Abuse Hotline information sheet.

You can report these type of allegations at the State Fraud and Abuse Hotline.