32 Miss. Code. R. 1.20
MDRS/OSDP endorses the concept that people who provide services are essentially honest and are entitled to the same protection under the law as all other individuals. However, when there is an indication of potential fraud, the allegations must be investigated.
MDRS/OSDP is responsible for identifying, investigating, and referring cases of suspected fraud or abuse of Medicare or Medicaid.
To help carry out this responsibility, OSDP must be prepared to exclude paying for services when any provider defrauds or abuses the Medicare or Medicaid program.
To determine the existence of fraud and/or abuse, the following must be established:
* intentional misstatement or concealment by direct care worker or vendor created a false impression;
* MDRS/OSDP paid the direct care worker or vendor based on the false impression, when the payment would not have been made if the truth had been known; or
* practices are inconsistent with sound fiscal, business practices, and these inconsistent practices result in unnecessary cost to the program and payment for services that were not provided.
Examples of fraud include, but are not limited to:
* billing for services not rendered;
* requesting, offering, or receiving a kickback, bribe, or rebate;
* using an incorrect or inappropriate provider number in order to be paid;
* selling or sharing patients' Medicare/Medicaid numbers so false claims can be filed;
* falsifying information on applications, medical records, billing statements, and/or cost reports or on any statement filed with the government;
* submitting time and task (services) which were not provided;
* filing a false timelog/authorization/claim;
* submitting a false invoice;
* billing for equipment/supplies never ordered;
* billing Medicaid/Medicare for new equipment but providing the client used equipment;
* billing Medicaid/Medicare for expensive equipment but providing client used equipment;
* billing Medicaid/Medicare for expensive equipment but providing the client cheap equipment; and
* charging more than once for the same service.
32 Miss. Code. R. 1.20