Call the Wyoming Attorney General's Medicaid Fraud Control Unit at 307-777-3444, or toll free 1-800-378-0345. You may also email complaints to ag.medicaid.fraud@wyo.gov, or file a report online by clicking here. A printable copy of the form is also available here. 

You can also report provider fraud to the Wyoming Department of Health, Division of Healthcare Financing, Program Integrity Unit at 307-777-7531 or toll free 1-855-746-2563, or file a report online by clicking here. 

Medicaid is a state and federal partnership which provides medical benefits to children, pregnant women, families with children, and individuals who are aged, blind, or disabled in Wyoming. The federal and state governments have established eligibility criteria for the Wyoming Medicaid program. Eligibility is based on residency, income, and sometimes resources or healthcare needs. Individuals looking for more information about the Wyoming Medicaid program can find more information on the program's website. 

Whistleblowers, Medicaid recipients, Medicaid providers, and other Wyoming citizens are our most common source of referrals. The MFCU also receives referrals from state and local law enforcement agencies, the Wyoming Department of Health, Wyoming Department of Family Services, and the United States Department of Health and Human Services. We also find new cases while investigating other referrals. 

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Most health care providers are honest and provide quality services. Provider fraud still costs Medicaid millions of dollars. Medicaid fraud hurts taxpayers by diverting state funds from their intended purpose. Medicaid fraud hurts participants by limiting the funds available for their medical needs. 

Medicaid fraud involves the knowing using a false statement, a misrepresentation, or the failure to disclose a material fact in providing medical assistance in the Medicaid program. Medicaid fraud is a felony if the value of the assistance is over $500, otherwise, it's a misdemeanor.  

Medicare is a federally administered health insurance program for individuals age 65 or older, individuals receiving Social Security Disability Insurance, or individuals with End-State Renal Disease. The MFCU can only investigate Medicare fraud if the cases is primarily related to Medicaid and with the consent of the U.S. Department of Health and Human Services, Office of the Inspector General. You can report Medicare fraud by calling 1-800-MEDICARE (1-800-633-4227), 1-800-HHS-TIPS (1-800-447-8477), TTY 1-800-337-4950, or by visiting the Medicare.gov website. 

There is no single example of Medicaid fraud. Medicaid fraud can include some medical services, or no service at all. Typical fraud schemes include unnecessarily increased costs, the overuse of resources, or inaccurate payments. Here are some common schemes used by criminals who take money from the program: 

• Billing for medical goods or services that were not provided;
• Paying or accepting a “kickback” in exchange for a medical referral;
• Concealing ownership in a related company;
• Using false credentials;
• Billing twice for the exact same service or item;
• Billing Medicaid and the participant for the same service or item;
• Billing a more expensive service than the one actually provided;
• Prescribing or providing an unnecessary service; or
• Forging patient records or service documentation.

Medicaid participants can help prevent fraud by staying alert and protecting their information. Examples of ways that you can protect yourself include: 

• Regularly review your medical bills to ensure charges and dates are correct; 
• Ask for a copy of everything you sign; 
• Be suspicious of anyone offering tests in exchange for your Medicaid number; 
• Only share your Medicaid number, records, and other information with your medical providers; 
• Don’t consent to or ask for medical treatment that you don’t need; and 
• Don’t sign blank medical forms.

Most importantly: If you know of or suspect fraudulent activities, report it!

The Medicaid Fraud Control Unit can review, investigate, and prosecute cases of abuse, neglect, and misappropriation of patient funds in Medicaid facilities and board-and-care facilities.

Abuse means intentional or reckless injury, unreasonable confinement, cruel punishment, sexual abuse, intimidation, or exploitation. Abuse can be caused by a caregiver, family member, persons of trust or authority, or a stranger. 

Neglect means taking or failing to provide a patient’s food, shelter, clothing, supervision, physical or mental health care, or medication needed to avoid physical or mental harm or illness. 

Misappropriation means temporarily or permanently exploiting, wrongfully using, or intentionally misplacing a resident’s property or money.

Board-and-Care means a residential setting where two or more unrelated persons live and receive nursing care or substantial assistance with their activities of daily living. The MFCU investigates abuse and neglect in board-and-care facilities regardless of the payment source. 

There is no single from of abuse, neglect, or misappropriation. Patients may suffer physical, emotional, or financial harm as a result of these crimes. Patients, family members, caregivers, and concerned citizens can be on the look out for these common signs: