Provider Fraud

The Medicaid Fraud Control Unit investigates and prosecutes fraud and abuse committed by physicians, hospitals, laboratories, pharmacists, dentists, ambulance and taxi services, sellers of durable medical equipment, and other service providers. The MFCU seeks to recover monies improperly paid by the Medicaid program and to prosecute criminal conduct.

A provider is any person or entity who bills the South Dakota Medicaid Program for goods or services provided to a Medicaid recipient. The actual fraudulent schemes engaged in by dishonest providers are too numerous to count.

A few examples of common provider fraud schemes include billing:

  • for services not actually performed or goods not actually provided
  • for a more expensive service than was actually rendered
  • for several services that should be combined into one billing
  • twice for the same goods or services
  • the Medicaid Program and the recipient's family for the same goods or services
  • for unnecessary medical services

Dispensing generic drugs and billing the Medicaid Program for the brand-name drug is another common provider fraud scheme.

To report allegations of Provider Fraud, fill out our online COMPLAINT FORM.