Reporting Health Care Fraud

Health care fraud is a significant problem faced by all State, Federal and private health plans.  To address this ever growing and costly problem, the Department for Medicaid Services (DMS) works in conjunction with the Office of the Inspector General (OIG) to combat fraud and abuse.

DMS actively refers any suspicious or questionable activity identified by staff or reported by an outside source to the OIG for thorough and timely review.  Investigators skilled in the detection and investigation of fraud and abuse actively review all referrals and evaluate the need for further action.  Use the following web site link to connect you directly to the Office of the Inspector General.

http://chfs.ky.gov/oig/dsi.htm

Health care fraud is defined as:  "An intentional act of misrepresentation or deception that results in a higher benefit to the beneficiary, the provider or some other entity."

Potential violators may be a physician or other practitioner, a hospital or other institutional provider, a clinical lab or supplier, an employee of any provider, a billing service, a beneficiary, a Medicaid employee, or any person in a position to file a medical claim.

Suspicious or questionable activity can be reported several different ways.  Details on how to notify the Office of the Inspector General (OIG) are provided below.  Please be aware that all reports/suspicions of fraud and abuse remain confidential.

• By Phone:
  The Office of the Inspector General (OIG) operates a toll free fraud hotline.  The number is:
  1-800- 372-2970
  Weekday hours of operation are from 8:00 a.m. to 4:30 p.m. Eastern time.  If a call is made after these hours please leave a detailed message.
  
  
• By Mail:
  Please mail any fraud and abuse issues to the following address:
  Cabinet for Health and Family Services
  Office of the Inspector General
  Division of Special Investigations
  275 East Main Street, 5 E-D
  Frankfort, Kentucky 40621
  
  
• By Web:
  You can link to the Office of the Inspector General's web site by using the following link:
  http://chfs.ky.gov/oig/dsi.htm
  

By reporting suspicious or questionable activity, we guarantee a thorough and timely review of all relevant information.  Please be aware that all reports/suspicions of fraud abuse remain confidential.