Division of Developmental Disabilities (DDD) Fraud Unit

Medicaid Fraud:

Fraud and abuse of Medicaid funds reduces valuable dollars needed to assist individuals with developmental disabilities. The DDD Fraud Unit takes all suspected cases of fraud seriously and investigates all reports. The Fraud Unit will determine if the case will be referred to the Office of the Inspector General (OIG) for further investigation. Examples of fraud and abuse can include: Billing for services not provided Billing for a more expensive service than what was provided, known as upcoding Substitution of services Falsifying billing documentation Submitting false credentials

Helpful links for services and billing guidance:

DDD Waiver Manual

• IDHS: VI. Waiver Activities and Services
• IDHS: XII. Waiver Activity and Service Billing Guidance
• IDHS: A. Billing Guidance by Activity/Service Type
• IDHS: Self Direction Assistance Guidelines UPDATED 12.28.22
• IDHS: Developmental Disabilities Program Manual

Contact:

If you suspect fraud by a service provider please contact Terri Smith immediately.

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