abercrombie
12-05-2012, 05:47 PM
Program Integrity - Fraud or Misuse
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The vast majority of our providers and recipients are honest; unfortunately a few dishonest people can do great damage to our programs. Each dollar lost to theft is one less dollar available for someone in need of care. We need to work together to help stop fraud and misuse; otherwise, the system might not be available for those whom the program was created to help.
Reporting Fraud or Misuse
You may report suspected fraud and misuse using any of the following methods. You may remain anonymous if you desire.
Fraud Unit at (401) 415-8300. This line is staffed Monday thru Friday from 8:30 a.m. to 4:00 p.m. After hours and weekends you may leave a message on an answering machine or by emailing us at: fraud@dhs.ri.gov
Downloadable Form for Report Suspected DHS Program Ineligibility, Misuse or Fraud (pdf) - Free Adobe® Reader® 7.0
Fax Information to (401) 415-8513.
Mailing Address: Collection, Claims, & Recovery/Fraud Unit
206 Elmwood Avenue
Providence, RI 02907
Online Form for Report Suspected DHS Program Ineligibility, Misuse or Fraud
WHAT IS WELFARE FRAUD AND MISUSE?
Welfare Fraud occurs when a person(s) makes false statements, and/or misrepresents facts or circumstances to the Department of Human Services (DHS) in order to obtain Cash Assistance (FIP & GPA), Medical Assistance (including RIte Care, RIte Share, and Long Term Care services), Food Stamps, Child Support, Child Care, In-Home Support Services.
WHAT ARE THE DIFFERENT KINDS OF FRAUD AND MISUSE?
Failure to report income or money received.
Failure to report the return of the absent parent to the home.
Failure to report a child out of the home.
Failure to report property or assets.
Internal employee fraud.
Duplicate Aid.
Forgery or stolen identity.
Receiving Public Assistance Benefits to which they are not entitled.
Welfare recipients also commit fraud when they continue to receive Cash Assistance, Medical Assistance, Child Support, Child Care, Food Stamps and General Assistance benefits that they are not entitled to, which generates an overpayment of monies or benefits in their case.
PROVIDER FRAUD involves not only child care providers and doctors, but nursing homes, home health, durable medical equipment, pharmacies, mental health facilities, laboratories, transportation, and dentists to name a few.
MISUSE is provider practices that are inconsistent with sound fiscal, business, or medical practices, and results in an unnecessary cost to the Medicaid program (as well as other assistance programs managed by DHS) or in reimbursement of services that are not medically necessary or that fail to meet professionally recognized standards for health care. It also includes recipient practices that result in unnecessary cost to the Medicaid program.
Examples of fraud and misuse include unreported income or insurance, recipients living out of state, drug seeking behavior, incarceration, recipients receiving bills for services never provided, provider billing irregularities, and misrepresentation of credentials.
Change Language English Spanish Portuguese
The vast majority of our providers and recipients are honest; unfortunately a few dishonest people can do great damage to our programs. Each dollar lost to theft is one less dollar available for someone in need of care. We need to work together to help stop fraud and misuse; otherwise, the system might not be available for those whom the program was created to help.
Reporting Fraud or Misuse
You may report suspected fraud and misuse using any of the following methods. You may remain anonymous if you desire.
Fraud Unit at (401) 415-8300. This line is staffed Monday thru Friday from 8:30 a.m. to 4:00 p.m. After hours and weekends you may leave a message on an answering machine or by emailing us at: fraud@dhs.ri.gov
Downloadable Form for Report Suspected DHS Program Ineligibility, Misuse or Fraud (pdf) - Free Adobe® Reader® 7.0
Fax Information to (401) 415-8513.
Mailing Address: Collection, Claims, & Recovery/Fraud Unit
206 Elmwood Avenue
Providence, RI 02907
Online Form for Report Suspected DHS Program Ineligibility, Misuse or Fraud
WHAT IS WELFARE FRAUD AND MISUSE?
Welfare Fraud occurs when a person(s) makes false statements, and/or misrepresents facts or circumstances to the Department of Human Services (DHS) in order to obtain Cash Assistance (FIP & GPA), Medical Assistance (including RIte Care, RIte Share, and Long Term Care services), Food Stamps, Child Support, Child Care, In-Home Support Services.
WHAT ARE THE DIFFERENT KINDS OF FRAUD AND MISUSE?
Failure to report income or money received.
Failure to report the return of the absent parent to the home.
Failure to report a child out of the home.
Failure to report property or assets.
Internal employee fraud.
Duplicate Aid.
Forgery or stolen identity.
Receiving Public Assistance Benefits to which they are not entitled.
Welfare recipients also commit fraud when they continue to receive Cash Assistance, Medical Assistance, Child Support, Child Care, Food Stamps and General Assistance benefits that they are not entitled to, which generates an overpayment of monies or benefits in their case.
PROVIDER FRAUD involves not only child care providers and doctors, but nursing homes, home health, durable medical equipment, pharmacies, mental health facilities, laboratories, transportation, and dentists to name a few.
MISUSE is provider practices that are inconsistent with sound fiscal, business, or medical practices, and results in an unnecessary cost to the Medicaid program (as well as other assistance programs managed by DHS) or in reimbursement of services that are not medically necessary or that fail to meet professionally recognized standards for health care. It also includes recipient practices that result in unnecessary cost to the Medicaid program.
Examples of fraud and misuse include unreported income or insurance, recipients living out of state, drug seeking behavior, incarceration, recipients receiving bills for services never provided, provider billing irregularities, and misrepresentation of credentials.