Medicaid Fraud

P.O. Box 40114 - Olympia, WA - 98504 - (360) 586-8888

Established in 1978, the Washington State Medicaid Fraud Control Division (MFCD) is responsible for both criminal and civil investigation and prosecution of healthcare provider fraud committed against the State’s Medicaid program. The division also investigates and prosecutes complaints of resident abuse or neglect in nursing homes, adult family homes and assisted living. RCW 74.66 and 74.67

What is Medicaid?

Medicaid and Medicare started in 1964.  Medicare provides health insurance to people age 65 and over and those who have permanent kidney failure and certain people with disabilities.  Medicaid, on the other hand, is health insurance for qualifying low-income and needy people.  Medicaid eligible recipients can include children, the elderly, and persons with a disability.

Each state designs and administers its own Medicaid program.  The federal government jointly funds the program as long as the program complies with the requirements mandated by the Centers for Medicaid and Medicare Services (CMS). 

Medicaid covered services include hospital care, skilled nursing home care, residential adult family care services, and professional services provided by physicians, and laboratories. Washington Medicaid also includes hospice, mental health, dental services and eyeglasses.

The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the U.S. Department of Health and Human Services. You can learn more about the programs online at http://www.cms.hhs.gov/.

 Who Are Providers?

Providers can be any of the following:

• Pharmaceutical manufacturers
• Doctors
• Nurses
• Clinics
• Hospitals
• Nursing homes
• Adult family homes
• Assisted Living Facilities
• Laboratories
• Pharmacies
• Ambulance and transportation companies
• Home health care providers
• Medical equipment suppliers

What is Fraud?

Examples of Medicaid Fraud are billing the Medicaid program for services, drugs, or supplies that are intentionally or knowingly:

• Unnecessary
• Not performed or are of a lower quality
• More costly than those actually performed
• Purportedly covered items, which were not actually covered

Qui Tam Whistleblower / Medicaid Fraud

Whistleblowers who bring qui tam actions must serve a copy of their complaint and written disclosure of substantially all material evidence and information the person possesses on the Attorney General in electronic form.  The Attorney General’s Office does not accept service by e-mail communication unless a written request is made and written approval is given.  Acceptable electronic formats include a CD, DVD or flash drive. 

Please send materials to:

Washington Attorney General's Office
Medicaid Fraud Control Division
P.O. Box 40114
Olympia, WA 98504