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Fraud and Abuse

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Health care fraud is a significant problem faced by all State, Federal and private health plans. To address this ever growing and costly problem, the Department for Medicaid Services (DMS) works in conjunction with the Office of the Inspector General (OIG) to combat fraud and abuse.

DMS actively refers any suspicious or questionable activity identified by staff or reported by an outside source to the OIG for thorough and timely review. Investigators skilled in the detection and investigation of fraud and abuse actively review all referrals and evaluate the need for further action.

For more information on Fraud and Abuse, click on the links listed below:  

What is Fraud and Abuse?
How do I report health care fraud and abuse?
Preventing Fraud and Abuse


Laws and Publications

Code of Federal Regulations (CFR)
42 CFR 433

Kentucky Administrative Regulations (KAR)
907 KAR 1:671
907 KAR 1:672 
907 KAR 1:675



Contact Information

For Policy questions, contact
Division of Program Integrity
Recovery Branch
275 East Main Street, 6E-A
Frankfort, KY 40621
(502) 564-1012

To report Fraud and Abuse, contact
Cabinet for Health and Family Services
Office of the Inspector General
Division of Audits and Investigations
275 East Main Street, 5 E-D
Frankfort, Kentucky 40621
Toll fee: (800) 372-2970
Monday to Friday
8 a.m. - 4:30 p.m. ET

Note: If a call is made after these hours please leave a detailed message. 

For member eligibility questions, contact
Member Services at (800) 635-2570

For more information regarding the Human Service Transportation Delivery, contact: Office of Transportation Delivery for program policies and complaints at
(888) 941-7433


Last Updated 4/6/2017