Medicaid Billing Fraud: Billing Medicaid for services that were never rendered, for a quantity of services greater than what was provided, or for services rendered to patients who were not present or eligible on the date of the claim. This is one of the most common forms of Medicaid fraud and is frequently discovered by billing staff, coders, and clinical employees who see the discrepancy between what was provided and what was billed.

Upcoding: Billing Medicaid for a more expensive procedure or service code than was actually provided. Providers who upcode receive a higher reimbursement than they are entitled to, at the expense of the Medicaid program and the federal and state governments that fund it.

Billing for Services Never Performed: Submitting claims to Medicaid for services, treatments, or visits that did not occur. This includes billing for patients who were hospitalized elsewhere on the date of service, billing under the identity of a treating provider who did not perform the service, and submitting claims for treatments documented in falsified medical records.

False Patient Eligibility Certification: Some fraud schemes involve providers falsely certifying that patients meet the eligibility criteria for specific Medicaid-funded services, such as home health, hospice, or behavioral health programs, when those patients do not qualify. Submitting a false certification to obtain Medicaid payment constitutes a false claim under the False Claims Act and state false claims acts.