Fraud and abuse laws apply to the VFC Program.

Fraud is defined as in intentional deception that could result in a benefit to the provider/practice or other person.

Abuse is defined as provider practices that are inconsistent with requirements resulting in unnecessary costs or actions to the Medicaid, VFC or insurance programs or patients.

Fraud and Abuse Examples*

• Failing to comply with any part of the VFC Provider Agreement
• Providing VFC vaccine to non-VFC-eligible children
• Selling or otherwise misdirecting VFC vaccine
• Billing a patient or third party for VFC vaccine
• Charging more than the established vaccine administration fee
• Over-ordering VFC vaccine
• Waste of VFC vaccine
• Denying VFC-eligible children VFC-funded vaccine due to the parent’s inability to pay the vaccine administration fee
• Failing to screen for and document eligibility at each immunization contact
• Failing to maintain VFC records for a minimum of three years
• Failing to fully account for VFC vaccine
• Failing to properly store and handle VFC vaccine

* This list provides examples and is not considered comprehensive.

Any person may contact the VFC Program to report possible concerns or questions. Reports may be anonymous, and all are considered confidential. Please call the toll-free number 800-219-3224 to make a report.