Abuse means provider actions that don't follow appropriate fiscal, business or medical practices. This leads to an unnecessary cost to the Medicaid program. It also leads to spending money for services that aren't medically necessary. Abuse includes actions that don't meet professional standards for health care. Abuse also includes a member's actions leading to added cost to the Medicaid program.

Example of Abuse

Jonathan’s doctor asked for x-rays and blood tests and gave a physical exam of Jonathan. But Jonathan only wanted to see the doctor to remove a wart on his finger.

This is an example of abuse because the doctor asked for more tests than what the patient needed.