Federal rules require that Medicaid providers take steps to prevent fraud
and abuse. This includes:
- Billing Medicaid correctly for services actually provided to
recipients
- Advising Medicaid regarding changes in status, such as when
a doctor leaves a provider group or clinic
- Ensuring that the care provided to recipients is medically
necessary and rendered in a manner that is consistent with
current medical practice
- Reporting recipients who "doctor shop" in an effort to
obtain prescription drugs that can be sold "on the street"
Cases of suspected provider fraud and
patient abuse are referred to the Medicaid
Fraud Control Unit in the Alabama Attorney
General's Office. Providers in violation of
Medicaid rules and regulations may receive
administrative or other sanctions,
suspension of payments, limits on
participation in the Medicaid program, or
termination from the program.