COVID-19 Information

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Medicaid & Public Assistance Fraud

DIA investigates reported instances of Medicaid fraud in order to prevent the abuse of taxpayer resources. Criminal investigators, auditors, and attorneys are all a part of the investigations DIA conducts in order to determine if fraudulent activity has taken place. Cases are referred to DIA by the Iowa Department of Human Services (DHS).

Medicaid Provider Fraud

Types of Medicaid fraud by a healthcare provider:

  • Fraud committed against the Medicaid program, as well as fraud in the administration of the Medicaid program
  • Abuse or neglect of residents in health care facilities that receive funding from the Medicaid program

Iowans can help recognize instances of provider Medicaid fraud in order to protect the future of Medicaid and the tax dollars of Iowans. The following are instances of potential Medicaid fraud:

  • Billing for medical services or products not actually provided
  • Billing for a more expensive service or product than was actually provided
  • Billing for several services that should be combined into one billing (unbundling)
  • Billing twice for the same medical service using two different service dates
  • Dispensing less-costly drugs and billing for higher-priced equivalents
  • Giving or accepting kickbacks for medical services
  • Providing unnecessary services

Public Assistance Fraud

DIA investigates potential fraud in DHS-administered public assistance programs, directly referred to DIA by DHS. 

Some public assistance fraud investigated by the department:

  • Food Assistance/Supplemental Nutrition Assistance Program (SNAP)
  • Family Investment Program (FIP)
  • Refugee Cash Assistance
  • PROMISE JOBS
  • Child Care Assistance
  • State Supplementary Assistance
  • Health Insurance Payment Premium
  • Hawk-i program

Report Fraud

To report Medicaid provider or Public Assistance fraud, contact the Iowa Medicaid Enterprise (IME) Program Integrity Unit via email at fwareports@dhs.state.ia.us, or by phone at 515.256.4615 or 1.877.446.3787 (toll-free).