Medicaid Fraud by a Beneficiary

WHAT IS MEDICAID FRAUD BY A BENEFICIARY?

Medicaid pays for the medical expenses of many Puerto Rican residents who cannot afford a medical plan.

Unfortunately, there are people who sometimes get the benefits of the Medicaid Program (Vital Plan) by lying or hiding information.

DOES MEDICAID FRAUD AFFECT ME?

Medicaid fraud affects everyone!

The more people lie to get the benefits of the Medicaid Program without qualifying for it, Puerto Rico will have less money available for those who need it. In reality, all residents of Puerto Rico taxpayers pay the cost of this crime. As a consequence, Puerto Rico has to cover fraud losses by reducing other government services and raising contributions.

COMMON FORMS OF FRAUD BY A BENEFICIARY

• Provide false information when applying for Medicaid / Vital Plan benefits.
• Hide income and resources when applying for the benefits of the Medicaid Program / Vital Plan.
• Utilizar la tarjeta del plan médico de otra persona que sea beneficiaria del Programa Medicaid/Plan Vital.

HOW CAN YOU AVOID COMMITING FRAUD TO MEDICAID?

Report any socio-economic change that arises in your family unit, as soon as it occurs. Such as:

• Increase in your income and / or decrease in them
• Change in your civil status (marriage, divorce, widowhood)
• At age 21 or 65
• Death
• Moving out of Puerto Rico

These changes are significant when determining your Medicaid eligibility. Remember that Offering false information is appropriating services to which you are not entitled, which constitutes a crime sanctioned by both state and federal laws.

WHAT TO DO IF YOU SUSPECT FRAUD AGAINST MEDICAID BY A BENEFICIARY?

If you suspect fraud, call the Medicaid Anti-Fraud Unit (787) 765-2929 Exts. 6719, 6722, 6725, 6726 and 6727 or write to fraudemedicaid@salud.pr.gov.

All information you provide to us will be handled confidentially.