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Fraud and Other Recoveries

Medicaid fraud is a deliberate withholding or hiding of information or giving false information to get Medicaid or Healthy Connections benefits. Medicaid fraud also occurs when a provider bills Medicaid for services that were not delivered to a Medicaid recipient, or that were not medically necessary. Medicaid fraud also occurs if a recipient shares his/her Medicaid number with another person to get medical care. The South Carolina Department of Health and Human Services (SCDHHS) conducts preliminary investigations of anyone suspected of Medicaid fraud or abuse, and refers cases to the South Carolina Attorney General’s Office for prosecution. Medicaid fraud is a criminal act. Anyone convicted of Medicaid fraud must repay the Medicaid program for losses (paid claims and managed care premiums), and penalties can include fines and/or prison terms.

If you suspect fraud or abuse on the part of any Medicaid beneficiary or Medicaid provider, you should report it to SCDHHS on its toll-free fraud hotline at 1.888.364.3224 or via email at fraudres@scdhhs.gov.

This information can also be found in the Medicaid Manual.