Protecting Vital Resources
Public assistance programs are critical lifelines that provide access to essential needs for millions of Pennsylvanians. The Department of Human Services works in collaboration with the Office of State Inspector General to identify and investigate potential fraud and abuse of public assistance programs so they’re protected for those who need them most.
Anyone who suspects potential fraud or abuse of programs like Medicaid, the Supplemental Nutrition Assistance Program (SNAP), cash assistance, or other benefits programs should call the Fraud Tip Hotline at 1-844-DHS-TIPS (1-844-347-8477).
What is public assistance fraud?
This occurs when someone is applying for assistance for themselves or a household member and includes:
- Not disclosing or reporting income when required;
- Not disclosing or reporting ownership of resources (like vehicles) or property when required;
- Not reporting other insurance or third-party liability sources when required; or,
- Not reporting who lives in their household.
Falsifying Medicaid claims is something done by providers participating in the pgoram and may include:
- Providing substandard or inappropriate care;
- Discriminating against, neglecting, or abusing patients;
- Billing for care or services that did not occur;
- Billing for services individually when they should be bundled to receive a higher payment;
- Misrepresenting services or supplies rendered to receive a higher payment;
- Altering claims;
- Submitting false data on claims;
- Duplicating billing for the same service;
- Underutilizating or limiting access to services;
- Billing for services by unlicensed or unqualified providers; or,
- Billing for used items as new.
This occurs when providers paid to provide services through a public assistance program:
- Falsify credentials or qualifications to participate in a program or provide services;
- Engage in discrimination, neglect, or abuse;
- Use fraudulent enrollment practices;
- Falsify services offered;
- Offer free services in exchange for personal information about a public assistance recipient;
- Accept kickbacks or make payments for referrals to services; or,
- Conceal ownership of related companies.
This can occur when benefit recipients or others, such as retailers participating in SNAP:
- Sell (also known as traffick) SNAP benefits; or
- Sell items purchased using SNAP benefits.
The majority of people who receive public assistance or provide services paid for through public assistance programs do so honestly. However, misuse of programs can still occur.
If you suspect abuse or fraud of public assistance programs, report it to the Department of Human Services and the Office of Inspector General so concerns can be investigated. Penalties for fraud and abuse of public assistance programs include:
- Disqualification from receiving benefits in the future;
- Disqualification from offering services paid for through public assistance programs in the future;
- Repayment of stolen or misused funds;
- Federal or state criminal charges;
- Sanctions on professional licensure; and,
- If the recipient has used Medicaid (also known as Medical Assistance) services at a frequency or amount that is not medically necessary, as determined in accordance with guidelines established by the state, the agency may restrict that recipient to obtain Medicaid services from designated providers only.
Frequently Asked Questions
Yes, anyone reporting waste, fraud, and abuse can remain anonymous. Anyone wishing to remain anonymous should provide as detailed information as possible about the suspected waste, fraud, or abuse.