Oregon has a number of fraud and abuse laws relating to the Medicare and Medicaid programs.  The state’s Department of Human Services utilizes a number of program integrity approaches related to provider payments, such as medical review and prior authorization processes, provider obligations to submit correct claims, and investigations of fraud and prohibited kickback relationships.1  Oregon explicitly prohibits the knowingly submission of a false claim for payment to the Department of Human Services or the Oregon Health Authority, as well as accepting payment for the costs of items or services that have not been provided to a public assistance recipient.2

        In addition, the law lays out examples of fraudulent activity, which may include billing for services or equipment not provided to Medicaid patients, materially misrepresenting dates or services provided, or duplicative billing of the Medicaid program to obtain greater reimbursement.3  Providers also have an obligation to report all instances of suspected or actual fraud to the Medicaid Fraud Control Unit (MCFU) or to the Department of Human Services’ Provider Audit Unit.4  The law allows this information to be shared with the MFCU and other federal and state authorities for health oversight purposes.5