Idaho Medicaid Fraud Control Unit

The Attorney General’s Medicaid Fraud Control Unit (MFCU) investigates and prosecutes Medicaid fraud by health care providers and the abuse, neglect or financial exploitation of patients in any facility that accepts Medicaid funds.

Medicaid is a government program that provides services and health care to low income and medically needy people. Many of the people served by the Medicaid program are vulnerable adults – low income senior citizens and mentally, physically or developmentally disabled adults.

Medicaid Fraud is a crime that deprives Idahoans of needed health care and cheats Idaho taxpayers. The U.S. Department of Health and Human Services estimates 10% of Medicaid expenditures are fraudulent. If that is correct, it means Idaho taxpayers will be billed for $140 million of fraudulent expenditures this year.

The Attorney General’s Medicaid Fraud Control Unit investigates complaints of:

Medicaid Fraud,

Medicaid patient abuse and neglect in Medicaid-funded facilities and

Misappropriation of money belonging to any patient in a hospital, nursing home or other health care facility that receives Medicaid funds.

If you know about fraud, theft or abuse, please contact us, even if you only have suspicions, are not sure whether we can help or have already called the police or a state agency.

You can reach us at (208) 334–4100 or report suspected fraud, abuse or theft here.

Additional Contact Information

To report Medicaid recipient fraud, contact the Idaho Department of Health & Welfare at (866) 635-7515 or by e–mail at welfraud@dhw.idaho.gov.

Idaho Commission on Aging

U.S. Health and Human Services

U.S. HHS – Office of the Inspector General – tip hotline, Exclusion database

Idaho Medicaid Exclusion List

Employers: Check the HHS OIG Exclusion Database and the Idaho Medicaid Exclusion List to make sure you are not billing Medicaid for services associated with an excluded individual. Failure to do so may result in a $10,000 civil penalty for each claim.

File a report with the Medicaid Fraud Unit
Definitions of Medicaid Fraud Resources for Senior Citizens