Inside the Office > Criminal Division > Special Prosecution

Vulnerable Adults and Medicaid Provider Fraud (VAMPF)

Attorney General Alan Wilson’s Vulnerable Adults and Medicaid Provider Fraud unit targets fraud in the health care industry, including crimes against individuals in residential care facilities and criminal conduct by providers enrolled in the Medicaid program.

Title XIX of the Social Security Act created the Medicaid program. Medicaid is a governmentally funded (federal and state matching) health insurance program for the low-income, disabled and elderly. In 1977, the Medicare/Medicaid Anti-Fraud and Abuse Amendment was adopted, which created a nationwide system of Medicaid Fraud Control Units.

The South Carolina MFCU, now known as the Vulnerable Adults and Medicaid Provider Fraud Unit, also investigates and prosecutes physical abuse, neglect, and exploitation of certain vulnerable adults.

Vulnerable Adults

Vulnerable adult abuse or neglect occurs when a caregiver knowingly causes physical harm or fails to provide proper medical services to a Medicaid recipient living at home or when any individual fails to properly care for an individual living in a residential health care facility. Vulnerable adult exploitation occurs when a person steals money or property belonging to a resident of a facility.

VAMPF enforces South Carolina laws protecting Medicaid beneficiaries and vulnerable adults from neglect, abuse, and exploitation. Under South Carolina law, a Vulnerable Adult is someone eighteen years of age or older who has a physical or mental condition which substantially impairs the person from adequately providing for his or her own care or protection. This includes a person whose impairment is based on advanced age. A resident of a long-term care facility, such as an assisted living facility or nursing home, is a vulnerable adult. VAMPF is also permitted to investigate and prosecute Medicaid providers for abuse, neglect, and exploitation of Medicaid beneficiaries living at home.

The VAMPF investigates and, if appropriate, prosecutes individuals who abuse vulnerable adults and individuals who unlawfully use funds or assets of vulnerable adults.

What are typical forms of vulnerable adult abuse, neglect, and exploitation?

  • Intentionally deviating from the standard of care to such a degree that serious physical injury or death occurs.
  • Using physical force or restraints outside the course of approved medical treatment.
  • Diverting prescription drugs for the benefit of someone other than the individual to whom it is prescribed.
  • Improperly utilizing a vulnerable adult’s financial resources, particularly when such use is without permission or does not benefit the vulnerable adult.

How can I spot vulnerable adult abuse?
Signs abuse may be occurring include:

  • The appearance of any bruises, welts, lacerations, broken bones or burns; particularly when those injuries are inconsistent with the explanation for how they occurred.
  • Any significant changes in behavior that cause the individual to become fearful, mistrustful, withdrawn, or agitated.
  • Unusual financial transactions, particularly when someone else has access to the individual’s bank account or credit card and the transactions are for large sums, appear routinely, or are for goods or services the individual does not use.

Medicaid Provider Fraud

Medicaid provider fraud occurs when a Medicaid provider knowingly makes a false or misleading statement in order to be reimbursed from the Medicaid program.

VAMPF recovers taxpayer money by identifying, investigating, and prosecuting fraud committed by hospitals, nursing homes, clinical laboratories, pharmacies, doctors, nurses, home and respite care providers, transportation services, and other Medicaid providers.

VAMPF has the authority to hold individuals or entities accountable through criminal prosecution and/or civil litigation. The Unit also makes recommendations to the US Department of Health and Human Services’ Office of the Inspector General (HHS OIG) to exclude individuals or entities from participating in federally-funded programs.

What are typical Medicaid fraud schemes?
Typical schemes by which individuals and corporations steal from the Medicaid program include:

  • Billing for services not rendered
  • Billing for medically unnecessary services
  • Upcoding (billing Medicaid for more expensive procedures than those that are actually performed)
  • Double-billing (billing both Medicaid and a private insurance company or the recipient directly, or multiple providers billing Medicaid for the same recipient for the same procedure on the same date)
  • Kickbacks (hidden financial arrangements between providers involving some material benefit in return for another provider prescribing or using their product or services, which frequently results in unnecessary treatment)

How can I spot Medicaid fraud?
Medicaid recipients, their family members, and people who care for them can help combat Medicaid provider fraud by monitoring Beneficiary Explanations of Medicaid Benefits and using caution when providing a Medicaid ID number.

Keep a lookout for unusual activity, such as:

  • charges for services that were never performed, or for goods you never received.
  • charges from a person or business you are unfamiliar with.
  • multiple billings for the same service.
  • services that were not ordered by your doctor.
  • individuals who offer money or goods in exchange for your Medicaid ID number.

Providers who defraud the Medicaid program not only steal from the taxpayers at large, but also harm those populations eligible for benefits, such as by assigning a fictitious diagnosis in order to receive reimbursement for bogus claims, or by billing a beneficiary’s maximum allowed service amount, precluding that beneficiary from receiving treatment from a legitimate provider.

Where can I learn more?

VAMPF operates pursuant to a federal grant program operated by the Medicaid Fraud Unit Oversight Division located in the Office of Evaluations and Inspections of the United States Department of Health and Human Services’ Office of Inspector General (HHS-OIG). Additional information on the Unit’s jurisdiction and performance may be found at

VAMPF is a member of the Adult Protection Coordinating Council (APCC). The APCC is comprised of numerous public and private entities whose mission is to foster coordination and cooperation in a combined effort to protect South Carolina’s Vulnerable Adults. Information on the APCC’s structure and services may be found at

Information on the South Carolina Medicaid program and its commitment to maintaining program integrity may be found at

Report Fraud

If you have any information about Vulnerable Adult abuse or Medicaid Provider Fraud, please report it to Attorney General Alan Wilson’s Vulnerable Adults and Medicaid Provider Fraud unit at: [email protected]; (803) 734-3660 or call toll-free: 1-888-NO-CHEAT (1-888-662-4328). Tips can be made anonymously but reporters are encouraged to provide specific information if possible.

Or Mail Complaint to:
South Carolina Attorney General’s Office
Vulnerable Adults and Medicaid Provider Fraud
Post Office Box 11549
Columbia, SC 29211-1549