MEDICAID IS A FEDERAL HEALTH COVERAGE PROGRAM PROVIDING HEALTH CARE TO PEOPLE WHO ARE NOT ABLE TO PAY FOR IT THEMSELVES. THERE ARE TWO PARTIES WHO RECEIVE MEDICAID: RECIPIENTS AND PROVIDERS. TODAY WE ARE GOING TO LOOK AT THE MOST COMMON EXAMPLES OF MEDICAID FRAUD BY RECIPIENTS AND PROVIDERS.
MEDICAL FRAUD BY RECIPIENTS:
Falsification of Information
The eligibility requirements for Medicaid are extremely strict. If you lie or provide false information that does not match records and documents, you will be investigated.
Failing to disclose important information regarding income and/or assets
Attempting to hide any information will also raise an issue with investigators. You can’t lie or hide documented information.
Failing to update the program on income changes
Changes in income, living situation, or any information that is considered by the program should be reported.
Abuse of Benefits
Altering, forging, obtaining duplicate prescriptions, re-selling medicine, or products obtained through the program.
Cheating with Medicaid cards
If you allow another person to use your Medicaid card you are committing fraud.
Medicaid Fraud by providers:
Cheating the billing system
Billing for non-provided services, non-existent medical conditions or for services that were not medically necessary all fall under cheating.
Misrepresentation of provided services
Billing for more expensive services than actually performed, billing twice for the same service, dispensing generic drugs while billing for more expensive brand-name drugs.
Submitting false time records, signatures, or price reports, prescribing or filling fraudulent prescriptions, and more.
Violation of rules
Billing for services provided by unlicensed workers, billing for services provided by someone on an exclusion list.