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West Virginia Income Maintenance Manual Chapter 11

West Virginia Income Maintenance Manual

Page 29 Chapter 11 Benefit Repayment

11.4.2.B Unintentional Misrepresentation or Worker Error Unless intentional misrepresentation is established, repayment from the client is not pursued. BMS may pursue repayment from the provider of the medical services, but not from the client. 11.4.3 PROVIDER FRAUD If fraud on the part of any provider of Medicaid services is suspected, the Worker must submit a memorandum to the Medicaid Fraud Unit or complete the online reporting form. The memorandum must contain the following information: • Provider name and address • Reason fraud is suspected • Detailed explanation of the information accumulated that leads to the suspicion of fraud • Names and addresses of clients who might have knowledge that would help in a fraud investigation