Fraud is the intentional deception or misrepresentation that an individual knows, or should know, to be false, or does not believe to be true, and makes, knowing the deception could result in some unauthorized benefit to himself or some other person(s).
Waste is the over-utilization of services that are not medically necessary or practices that result in unnecessary costs.
Abuse describes provider practices that are inconsistent with sound fiscal, business or medical practices and result in unnecessary costs to Medicaid and Medicare.
Examples of Fraud, Waste and Abuse include:
Providing or accepting kickbacks.
Falsifying provider credentials
Fraudulent enrollment practices.
Double billing, upcoding
Billing for services not provided.
Substitution of services.
Not accurately reporting financial resources during enrollment.
Pursuant to Title VI of the Civil Rights Act of 1964, the Americans with Disabilities Act (ADA) and other nondiscrimination laws and authorities, ADES does not discriminate on the basis of race, color, national origin, sex, age, or disability. Persons that require a reasonable modification based on language or disability should submit a request as early as possible to ensure the State has an opportunity to address the modification. The process for requesting a reasonable modification can be found at Equal Opportunity and Reasonable Modification.