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Nebraska's Attorney General
The Nebraska Medicaid Fraud and Patient Abuse Unit (MFPAU) investigates and prosecutes Medicaid provider fraud and patient abuse and neglect.
About the Medicaid Fraud and Patient Abuse Unit
Medicaid is a program which provides health insurance for people who are unable to pay for such care, including disabled, elderly, and low-income patients. Medicaid is funded through both federal and State of Nebraska funds.
Medicaid providers are those doctors, dentists, hospitals, nursing homes, pharmacies, chiropractors, home health workers, medical equipment providers, and other persons and entities who are paid by the Medicaid program for the services they provide. Provider fraud occurs when a person or entity who is providing services to a Medicaid recipient misrepresents the services rendered to the State. The federal government requires that the State of Nebraska have a Medicaid Fraud and Patient Abuse Unit to recover money lost to fraud.
The MFPAU, as part of the Attorney General’s Office, is responsible for investigating and prosecuting Medicaid fraud and violations of all applicable state laws relating to the provision of Medicaid services and the activities of providers. The MFPAU has state-wide criminal jurisdiction over Medicaid provider fraud investigations and prosecutions. Additionally, the MFPAU has the authority to file civil actions under the False Medicaid Claims Act, Neb. Rev. Stat. § 68-934 et seq.
Abuse, Neglect, and Financial Exploitation
The MFPAU also reviews and can act on complaints of abuse and neglect of patients at health care facilities that receive Medicaid payments. This includes both physical abuse or neglect and financial exploitation of a patient. Physical abuse includes anything from excessive force in the course of a prescribed treatment, to striking or even sexually assaulting a resident. Neglect can include withholding necessary and adequate food, physical care or medical attention, such as turning a patient who cannot move themselves. Financial abuse includes misuse or unauthorized use of a person’s trust funds, bank accounts, cash, or credit accounts.
To file a Medicaid fraud or patient abuse complaint: click here.
Medicaid is a program that provides health insurance for people who are unable to pay for such care, including disabled, elderly, and low-income patients. Medicaid is funded through both federal and State of Nebraska funds.
Medicaid providers are any person or entity that provides goods or services to Medicaid recipients and receives Medicaid funding in return. This can include doctors, hospitals, mental health therapists, home health care workers, durable medical equipment providers, and many others. Medicaid provider fraud occurs when providers misrepresent services rendered to Medicaid patients. This misrepresentation can lead to the provider being overpaid.
Billing for services not rendered
Billing for more services than actually performed
Billing for equipment or prescribed medications that the patient enver received
Providing and billing for unnecessary services
Misrepresenting an unallowable service in a Medicaid building
Falsely diagnosing so Medicaid will pay for more services
The Medicaid Fraud and Patient Abuse Unit, or MFPAU, investigates and prosecutes cases of Medicaid fraud and physical and financial abuse of people living in facilities that receive Medicaid funding. The MFPAU has state-wide criminal jurisdiction over Medicaid provider fraud investigations and prosecutions. The MFPAU can also file civil actions under the False Medicaid Claims Act.
Medicaid fraud affects Nebraska taxpayers because tax dollars are wrongfully diverted for a provider’s personal use. This decreases the funds available to the program, which could otherwise be used for better patient care and/or higher payments to honest providers. Provider fraud can also result in Medicaid recipients not receiving important services they need, or receiving substandard or even harmful care.
Many of the cases investigated by the Medicaid Fraud and Patient Abuse Unit begin with information given to us by private citizens. Sometimes a fraud scheme begins with a provider offering “free” services in exchange for a patient’s Medicaid ID number. A provider might also recommend services that are unnecessary, or a patient might receive an explanation of benefits (“EOB”) that does not match the services they received. For patients in a nursing or long-term care facility, signs of abuse, neglect or exploitation might be seen in the patient’s appearance, the appearance of the room, or the patient’s personal funds account. If you suspect any cases of Medicaid fraud or patient abuse, we encourage you to contact us.
You can report it to Adult Protective Services at 1 (800) 652-1999, or contact your local law enforcement.
Lincoln and greater Nebraska: (402) 471-9407
Omaha: (402) 595-3789
No. Although Nebraska does have a false claims statute, there is no whistleblower provision in this law.
Contact the Department of Health and Human Services or call (402) 471-3121.