Medicaid Fraud Control Unit

THE MEDICAID FRAUD CONTROL UNIT protects the State of Connecticut and its taxpayers by investigating and prosecuting fraud committed by those health care professionals and facilities who provide services paid for by Medicaid, the government health insurance program for lower income people.

The Medicaid Fraud Control Unit was established in the Office of the Chief State's Attorney in 1978 as a result of federal legislation authorizing the states to investigate and prosecute fraud and abuse in Medicaid.

Providers can include physicians (medical doctors), dentists, nursing or convalescent homes, medical equipment supply companies, taxi and other transportation companies, or anyone else who bills the Connecticut Medicaid program for health care services provided to a Medicaid recipient.

Some examples of the types of fraud that can take place include:

  • Billing for treatment, medical procedures or equipment that is not actually performed or provided. Double billing, which means billing both the Medicaid program and the recipient or his or her private insurance for the same service. Billing for services that are not medically required.

  • Filling a prescription with a generic drug while billing Medicaid for the higher priced brand-name drug.

  • Kickbacks, or giving or accepting something in return for medical services.

  • "Up-coding," which is billing Medicaid for a more expensive procedure or service than was actually performed or provided.

The Medicaid Fraud Control Unit employs a professional staff of criminal investigators, auditors and prosecutors experienced in financial investigations. In addition to investigating and prosecuting fraud by those who provide health care services, the unit investigates cases of abuse of patients who reside in facilities that receive Medicaid funding.

Our work covers all facilities and all providers who receive Medicaid funding. It does not matter if the victim is on Medicaid -- as long as the facility gets Medicaid money, we can investigate, and we can prosecute.

For more information, contact:

Medicaid Fraud Control Unit
Office of the Chief State's Attorney
300 Corporate Place
Rocky Hill, CT 06067