MedicaidAdministrativeHigh impact
Incorrect Billing of Recipients
Maryland Medicaid·MD·General Provider
Effective date
Feb 16, 1999
We identified it
Jun 20, 2026
Summary
Maryland Medicaid providers are prohibited from balance billing recipients or charging them for covered services. Providers must accept Medicaid payment as payment in full and cannot collect co-pays or additional charges except in rare circumstances where recipients knowingly choose unauthorized services with signed documentation.
Action Required
Immediately: Stop all balance billing practices and charging Medicaid recipients for covered services. Billing team must update procedures to accept Medicaid payment as payment in full. Educate all staff on prohibition of collecting co-pays or additional charges from Medicaid recipients. Implement use of Eligibility Verification System (EVS) to verify coverage before billing. Obtain signed forms from recipients only when they knowingly choose unauthorized/uncovered services. Violation can result in sanctions or termination from Medicaid program.