Mike Hilgers

Nebraska Attorney General

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Medicaid Fraud and Patient Abuse Unit

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 coverage 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.

File Medicaid/Patient Abuse Complaint
 

Reporting Fraud Information

If you suspect that someone is being abused, neglected, or exploited, please report it immediately to your local law enforcement or the Adult Protective Services 24-hour hotline.
 

Adult Protective Services 24-Hour Hotline:  1-800-652-1999
 

Report Suspected Fraud or Abuse by a Provider to:
ago.medicaid.fraud@nebraska.gov
(402) 471-3549 or toll-free at 1-800-727-6432
download a PDF reporting form here

 

Report Suspected Fraud by Medicaid Recipients to:
Nebraska Department of Health and Human Services
DHHS.InvestigationsSIU@nebraska.gov
(402) 595-3789

 

Resources

Questions About Medicaid Benefits
National Medicaid Provider Exclusion List
Nebraska Provider License Information
NET: Health Care Fraud Costs Nebraska Millions

FAQ's About Medicaid Fraud & Patient Abuse

What is Medicaid?

Medicaid is a program that provides health coverage 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.

What is Medicaid provider fraud?

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.

What are some examples of provider fraud?

  • Billing for services not rendered
  • Double billing
  • Billing for more services than actually performed
  • Billing for equipment or prescribed medications that the patient never received
  • Providing and billing for unnecessary services
  • Misrepresenting an unallowable service in a Medicaid billing
  • Falsely diagnosing so Medicaid will pay for more services

What does the Medicaid Fraud and Patient Abuse Unit do?

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.

How does Medicaid provider fraud affect me?

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.

How can I spot Medicaid fraud?

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.

How can I report Medicaid provider fraud?

Office of the Attorney General
Attn: Medicaid Fraud and Patient Abuse Unit
2115 State Capitol
Lincoln, NE 68509-8920

File Medicaid/Patient Abuse Complaint

How can I report patient abuse, neglect, or financial exploitation?

You can report it to Adult Protective Services at 1 (800) 652-1999, or contact your local law enforcement.

Who do I contact if I suspect Medicaid recipient fraud?

Does Nebraska have a whistleblower statute?

No. Although Nebraska does have a false claims statute, there is no whistleblower provision in this law.

Who do I contact for other Medicaid questions?

Contact the Department of Health and Human Services or call (402) 471-3121.

  • Nebraska Attorney General
  • 2115 State Capitol
  • Lincoln, NE 68509
  • (402) 471-2683
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