Fraud Investigations, Statewide - DHW Admin

The Fraud Investigation Unit investigates fraud and abuse within the Medicaid program by monitoring and reviewing provider billing practices, and reviewing provider records to support services billed to the program. The Fraud Investigations Unit investigates Department-wide allegations of fraud to include Medicaid providers, Welfare programs, contractors, and they conduct Department internal investigations. The Fraud Unit has out-stationed investigators to respond to the statewide investigative need. They work with other state and federal agencies to investigate and prosecute providers and clients identified as defrauding the Medicaid and Welfare programs.

Welfare Fraud
Fraud and abuse significantly impacts the welfare programs by using up valuable dollars necessary to help eligible children and adults.

Fraud and abuse is actively pursued by Fraud Investigators within Health and Welfare. They investigate allegations of fraud being committed in Idaho Child Care Program (ICCP), Food Stamps, cash, medical, WIC and energy assistance. They initiate administrative, civil and criminal action against persons who abuse or commit fraud in the various welfare programs.

What is Welfare Fraud?
Welfare fraud is any intentional action which causes a participant or provider to receive benefits to which they are not entitled.

Common Fraud Schemes
*Providing false or incomplete information to the Department at application or re-certification.
*Failing to report changes.
*Submitting a false or fraudulent document to the Department in order to get benefits.
*Transferring, hiding or giving away assets in order to be eligible to receive benefits.
*ICCP providers billing for children not seen.

Report Welfare Fraud
Fraud and abuse of public programs affects all of us. Everyone can take responsibility to report fraud and abuse. There are three ways to report fraud and abuse of taxpayer money:

1. Call toll-free at 1-866-635-7515 - the Fraud Hotline rings into 2-1-1 for initial concern documentation.
2. E-mail a fraud complaint to: welfraud@dhw.idaho.gov; or
3. Fax or mail a fraud complaint to:
Fax a complaint form at 1-208-334-0686 or
Mail to: Welfare Fraud Investigations Unit, P. O. Box 83720, Boise, ID 83720-0036
If you are filling out a form, provide us with as much detail as possible and a contact name, phone number or e-mail address. This will help us if we have additional questions regarding the information you submit.

This program is administered by the Division of Management Services, Department of Health and Welfare.

Fraud Investigators:

Reg 1. Corey Thompson 208-665-8825
Reg 2. Howard Elliot 208-799-4416
Reg 3. Paula Hisle 208-442-9946
Reg 4. Dwayne Sanders 208-334-6725 or Eileen Williams 208-334-0610
Reg 5. Randy Reese 208-235-2831or Ben Johnson 208-528-5960
Reg 6. Ben Johnson 528-5960 or Randy Reese 208-235-2831
Reg 7. Ben Johnson 208-528-5960