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Health Care Fraud Division
Patient Rights And Responsibilities In Michigan Licensed Facilities
Partial list as provided by statute, MCLA 333.20201; MSA 14.15(20201)
- A patient or resident shall not be denied appropriate care on the basis of race, religion, national origin, sex, age, handicap, marital status, sexual preference, or source of payment.
- An individual may obtain or inspect his/her medical records and a third party shall not be given a copy without authorization of the patient except as required by law and third party contract.
- A patient or resident is entitled to privacy, to the extent feasible, in treatment and caring for personal needs with consideration, respect, and full recognition of his/her dignity and individuality.
- A patient or resident is entitled to adequate and appropriate care and to receive information about his/her-medical condition unless medically contraindicated by the physician in the medical record.
- A patient or resident is entitled to receive and examine an explanation of his/her bill. Also, he/she is entitled to know who is responsible for his/her care.
- A patient or resident is entitled to associate and have private communication with his/her physician, attorney or any other person, and to receive personal mail unopened, unless medically contraindicated. A patient's or resident's civil and religious liberties shall not be infringed and the facility shall encourage and assist in the exercise of these rights.
- A patient or resident is entitled to be free from MENTAL and PHYSICAL ABUSE and from physical and chemical restraints, except those necessitated by an emergency to protect the patient and/or others.
- A patient or resident is entitled to retain and use personal clothing and possessions as space permits. At the request of a patient, a nursing home shall provide for safekeeping of personal property, funds, and other property, except that a nursing home shall not be required to provide for the safekeeping of property which would impose an unreasonable burden on the nursing home.
- Each patient shall be provided with meals which meet the recommended dietary allowances for the patient's age and sex and may be modified according to special dietary needs.
- A health care facility, its owner, administrator, employee, or representative shall not discharge, harass, retaliate or discriminate against a patient because a patient has exercised rights protected by law.
- A patient or resident is entitled to adequate and appropriate pain and symptom management as a basic and essential element of his or her medical treatment.
What Does Medicare/Medicaid Fraud Look Like?
- Bill for services not provided, i.e. a chest x-ray when an x-ray was not taken;
- Duplicate Billing occurs when a provider bills Medicaid and the recipient or private insurance for the same service;
- Requires that the patient come back each week for the same problem or to get the same prescription when another appointment is not necessary, or a normal amount of medication could be prescribed;
- Upcode, i.e. identify a simple office visit as an emergency office visit or a comprehensive visit; or
- Take unnecessary x-rays, blood work or perform other unnecessary services.
Recipients Of Medical Services Should Remember
- When a professional service is used;
- Where the service takes place;
- Who takes care of you;
- What scheduled services are provided during the visit; and
- What additional non-scheduled services are provided.
If you suspect fraud, please call the Health Care Fraud Division Hotline: 800-24-ABUSE or (800-242-2873), to report your concern.
Center For Medicare & Medicaid Services (CMS)
Federal OIG Fraud and Abuse Information
P.O. Box 23489
Washington, DC 20026
Phone: HHS/OIG Hotline:
800-HHS-TIPS or (800-447-8477)