Vt. Medicaid Hospice Provider Manual § 21

Vermont Medicaid pays only for services that are actually provided and that are medically

necessary. In filing a claim for reimbursement, the code(s) should be chosen that most accurately

describes the service that was provided. It is a felony under Vermont law 33VSA Sec. 141(d)

knowingly to do, attempt, or aid and abet in any of the following when seeking to receive

reimbursement from Vermont Medicaid:

• Billing for services not rendered or more services than actually performed

• Providing and billing for unnecessary services

• Billing for a higher level of services than actually performed

• Charging higher rates for services to Vermont Medicaid than other providers

• Coding billing records to get more reimbursement

• Misrepresenting an unallowable service on bill as another allowable service

• Falsely diagnosing so Vermont Medicaid will pay more for services

For more information on overpayments and potential interest charges, visit the General Provider

Manual, section 6. Suspected fraud, waste or abuse should be reported to the DVHA Special

Investigations Unit at telephone 802.241.9210, or the Vermont Medicaid Fraud Control Unit of the

Vermont’s Attorney General’s Office, telephone 802.828.5511.