To report suspected fraud, waste, abuse, or other illegal acts related to Medicaid programs, please use one of the three options listed below:

Reporting Medicaid Fraud, Waste, or Abuse

Citizens may report to the Office of the Medicaid Inspector General (OIG) concerns about suspected fraud, waste, abuse, or illegal acts involving any Medicaid program, including but not limited to KanCare, MediKan, and the State Children’s Health Insurance Program (SCHIP). All complaints received by the OIG concerning those programs are reviewed by OIG staff and may become part of an audit or investigation.

K.S.A. 75-7427(k)(1) requires the OIG to “make provision to solicit and receive reports of fraud, waste, abuse, and illegal acts.” Any report of fraud may be submitted anonymously or confidentially to the OIG.

When to Report Fraud, Waste, or Abuse?

As soon as you discover it! The sooner you report, even if you think the matter is insignificant, the easier it will be for investigators to prevent further illegal actions by the perpetrators and/or stop others from being victimized.

What is considered Fraud, Waste, and Abuse?

Fraud is defined as the wrongful or criminal deception intended to result in financial or personal gain. Fraud includes false representation of fact, making false statements, or by concealment of information.

Waste is defined as the thoughtless or careless expenditure, mismanagement, or abuse of resources to the detriment (or potential detriment) of the State of Kansas government. Waste also includes incurring unnecessary costs resulting from inefficient or ineffective practices, systems, or controls.

Abuse is defined as excessive or improper use of a thing, or to use something in a manner contrary to the natural or legal rules for its use. Abuse can occur in financial or non-financial settings.

Complaints we investigate

Complaints about fraud, waste, abuse or illegal acts involving any Medicaid program from employees, grantees or contractors of entities involved in the management and/or operation of Medicaid programs (whistleblower complaints),
Crime, gross misconduct, or conflicts of interest involving employees, grantees or contractors of entities involved in the management and/or operation of Medicaid programs,
Fraud, waste, or abuse relating to Medicaid programs, grants or contracts,
False or fraudulent claims submitted to Medicaid,
Kickbacks or inducements for referrals by Medicaid providers,
Medical identity theft involving Medicaid beneficiaries,

Complaints not addressed by the OIG

Lost or stolen Medicaid card. Contact your MCO. (Aetna, United, Sunflower)
Complaints of failure to safeguard medical information, i.e. HIPAA violations. Contact HHS Office for Civil Rights
Customer service complaints involving Medicaid employees, grantees or contractors. Contact the Management of the relevant agency.
Identity theft or consumer scams unrelated to Medicaid programs. Contact the Public Protection Division, Office of the Kansas Attorney General
Social Security Disability fraud. Report it to Social Security Administration OIG
SNAP/Food Stamp Fraud. Report it to the Department of Children and Families Fraud Investigation Unit.
Issues relating to Medicare. File a complaint at Medicare.gov or call 1-800-MEDICARE

What You Need When Submitting Your Complaint

Our investigations are most successful when you provide as much information as possible about the allegation and those involved. The more you tell us, the better chance we have of determining whether an investigation can be pursued. Please be sure to include the following information in your complaint:

Name and contact information of the individual or business related to your complaint. This includes, if available, addresses, telephone numbers, e-mail addresses, etc.
A complete description of the facts and circumstances surrounding the reported activities, and how they relate to fraud, waste, abuse, or illegal acts of Medicaid programs.
How and when the reported activities were discovered.
The name and contact information of any witness(es) or other individual(s) who can help corroborate the information you are reporting.
Any and all supporting evidence that can be uploaded with your report in electronic format. This may include e-mail communications, documents, billing records or photographs.

What to Expect After Submitting Your Complaint

OIG investigative staff will review your complaint for relevance and completeness. Not all complaints result in an investigation. If you have identified yourself, a reviewing official may contact you for further information. However, if you are not contacted it does not mean your complaint is not being investigated.

The OIG will not respond to any inquiries about action taken on your complaint. We understand the natural inclination to follow up on a report but OIG does not provide the status of complaints.

Confidentiality

The identity of any person submitting a report to the OIG concerning fraud, waste, abuse, or illegal acts involving Medicaid programs shall remain confidential unless that person consents in writing to the disclosure of their identity. All information received by the OIG about suspected fraud, waste, abuse, or illegal acts shall not be made public unless: See K.S.A. 75-7427(o)

Release of the information would not result in the identification of the person who provided the information;
The person or persons who provided the information to be disclosed consent in writing prior to its disclosure;
The disclosure is necessary to protect the public health; or
The information to be disclosed is required in an administrative proceeding or court proceeding and appropriate provision has been made to allow disclosure of the information without disclosing to the public the identity of the person or persons who reported such information to the Inspector General.

NOTE: The OIG is not authorized to act as an attorney or private investigator and cannot directly assist in resolving individual complaints about the programs within the OIG's jurisdiction.

Contact Us:

To report suspected fraud, waste, abuse, or other illegal acts related to Medicaid programs, please use one of the three options listed below:

Email

Telephone

Online