The Bureau of 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 which provide essential medical services for needy 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.

Medicaid providers (e.g., doctor, dentist, counselor, etc.) should be referred to the Bureau 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; and/or,
• Violating Medicaid policies, procedures, rules, regulations, and/or statutes.

Medicaid beneficiaries should be referred to the Bureau 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 in helping us to fulfill our mission by ensuring that Medicaid dollars are used to provide quality healthcare and improve the lives of those who are entitled to services under the Medicaid program.

REPORT FRAUD NOW!

1-800-880-5920 FRAUD AND ABUSE HOTLINE