Combating Fraud

One of the most important roles a person can play in combating Medicaid fraud is to take the initiative to report fraud to An individual reporting fraud may be entitled to reward under RSMo. 191.907.

What Can I Do As a Provider?

The provider’s role in the billing process is often critical to ensuring fraud is not occurring. Simply hiring a billing agency does not negate the provider’s responsibility to ensure proper billing is occurring. Providers are encouraged to work closely with those billing on their behalf to verify the appropriateness and validity of claims submitted.

What Can I Do As a Participant?

Participants can assist in combating Medicaid fraud by guarding their Medicaid number and personal information. A participant who allows another individual to use their card is aiding in the commission of fraud and is subject to the same prosecutorial possibility as the individual who actually used the card.

A participant should also ensure they protect any medications from theft, and if theft occurs, report it to the appropriate authorities. Under no circumstance should participants obtain unnecessary medications, or take no longer needed medications, and sell them to other individuals.