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OIG Hotline:
Report Fraud, Waste and Abuse
866-770-7175
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Recipient Fraud Investigations
The mission of the Office of the Inspector General (OIG)
Recipient Fraud Investigations Division is to ensure that the Maryland
Medical Assistance (MMA) eligibility process is conducted on behalf of
the State is performed in an accurate and consistent manner in
accordance with the program policies and regulations.
At the time of application and throughout the period of
eligibility, it is essential that the applicant provides the Department
representative all relevant, accurate, and up-to-date information. This
will ensure that only those Maryland residents meeting the eligibility
standards receive benefits.
Recipient Fraud
Investigations consist of two divisions:
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Division of Medicaid Recipient Fraud: |
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Investigates allegations of recipient fraud; |
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Prepares formal reports for prosecutorial review by the
Office of the States Attorney. |
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§ Division of
Medicaid Special Projects: |
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Conducts periodic review of the Public Assistance Reporting
Information System (PARIS) and Maryland
Children’s Health Program (MCHP) cases. |
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Performs Special Project reviews, as assigned. |
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Highlighted Cases:
Long Term Care Recipient
The authorized representative (AR) for a Medical
Assistance Long Term Care (LTC) nursing home recipient failed to report
that the recipient owned a savings account with a balance of $81,892.16
which would make them ineligible for Medical Assistance benefits. The AR
transferred the assets to herself and her son. The OIG received a
referral from the Local Department of Social Services (LDSS) and
conducted an investigation into the allegation. The OIG referred the
case to the State’s Attorney Office for prosecutorial review. The AR was
charged with Medicaid fraud, convicted and ordered to make restitution
to the State of Maryland through the courts in the amount of $52,678.75.
Maryland Children’s Health Program (MCHP)
Recipient
The OIG
received a referral from the LDSS to conduct an investigation into the
Maryland Children’s Health Program (MCHP) eligibility of a recipient.
The allegation focused on the applicant’s reported household composition
and family income at the time of application. The OIG conducted an
investigation into the allegation and referred the case to the State’s
Attorney Office for prosecutorial review. The recipient was charged with
Medicaid fraud, pled guilty, sentenced and ordered to make restitution
to the State of Maryland through the courts in the amount of $17,821.96.
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