Who Are the Real Culprits?Recipients vs. Providers

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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:

  1. 1. 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.

  1. 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.

  1. 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.

  1. Abuse of Benefits

Altering, forging, obtaining duplicate prescriptions, re-selling medicine, or products obtained through the program.

  1. Cheating with Medicaid cards

If you allow another person to use your Medicaid card you are committing fraud.

Medicaid Fraud by providers:

  1. 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.

  1. 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.

  1. Falsifying information

Submitting false time records, signatures, or price reports, prescribing or filling fraudulent prescriptions, and more.

  1. Bribery

Some providers may choose to give or receive something in return for medical services or referrals.

  1. Violation of rules

Billing for services provided by unlicensed workers, billing for services provided by someone on an exclusion list.

By the time you receive notice of Medicaid Fraud investigation, the investigator has gathered evidence against you and you will need the assistance of an attorney. Contact an experienced Medicaid Fraud Attorney immediately.