What Should I Do About Medicaid Billing Fraud in New York?

Attorney Answer

Being billed for a Medicaid service you never received is a serious issue, and New York has specific channels set up to investigate exactly this kind of problem.

When a provider bills Medicaid, or bills you, for a service that was not actually performed, this can amount to health care fraud under New York law. New York Penal Law Article 177 makes it a crime for a provider to submit false health care claims, including billing for services not rendered. As the patient, you are not the one who did anything wrong here. Your role is to report what happened so it can be investigated and corrected.

Steps to take now:

1. Gather your records. Collect the billing statement, any Explanation of Benefits or Medicaid claim summary, appointment records, and any communication about the service in question. 2. Contact the provider's billing office first. Sometimes this is a coding or administrative error rather than intentional fraud, and it can be corrected quickly with a phone call and a written follow up. 3. Report it to the New York State Office of the Medicaid Inspector General (OMIG). OMIG investigates suspected Medicaid fraud, waste, and abuse, and has a public complaint line and online reporting form for exactly this kind of situation. 4. Consider reporting to the New York Attorney General's Medicaid Fraud Control Unit if you believe the billing was intentional rather than a mistake. This unit specifically investigates and prosecutes Medicaid fraud by providers. 5. Ask for a corrected claim in writing. If the provider agrees it was an error, get written confirmation that the claim was voided or corrected in Medicaid's system, so it does not affect your coverage or any cost sharing. 6. Watch for related charges. If one service was billed incorrectly, check your other recent Medicaid statements for similar problems.

You do not need to figure out on your own whether this rises to criminal fraud or is just a billing mistake. Reporting it to OMIG lets trained investigators make that call, and it also helps protect other Medicaid patients if there turns out to be a real pattern with this provider.

One important caution: this answer assumes you are the patient or Medicaid recipient reporting a billing problem. If you are a provider, or you work for one, and the concern is that your own office billed Medicaid for a service that was not completed, do not report anything before speaking with a lawyer. Provider billing problems can carry criminal exposure under the same laws, and a health care attorney or criminal defense attorney should guide your next steps.

This is general legal information and not legal advice about your specific situation. A local attorney, or a New York legal aid organization that handles Medicaid issues, can help you follow up if the provider or OMIG does not resolve this.