MedicaidAdministrativeMedium impact
MCO Medicaid Fraud Reporting
Maryland Medicaid·MD·Managed Care Organizations
Effective date
Oct 21, 2010
We identified it
Jun 20, 2026
Summary
Maryland MCOs must now report Medicaid fraud and abuse cases to state authorities, including provider billing irregularities over $5,000, criminal convictions, and network terminations for cause. This establishes mandatory reporting requirements with specific timelines and detailed information requirements.
Action Required
Immediately: MCOs operating in Maryland must establish monthly reporting procedures to owensp@dhmh.state.md.us and inathan@dhmh.state.md.us for any providers with overpayments exceeding $5,000, aberrant billing patterns, or suspected fraud/abuse. Report criminal conviction disclosures within 20 days. Include provider name, NPI, practice address, billing codes involved, and audit status in all reports.