7 examples of potential Medicaid fraud

On Behalf of | Dec 13, 2018 | Firm News

Navigating the world of Medicaid can be complex and confusing, but it’s critical to understand how this impacts patient services and financial operations. In some cases, doctors get accused of fraud for actions they take that do not line up with the government’s views on the Medicaid system.

If you’re facing these types of allegations, it’s incredibly serious. The ramifications could ruin your career and everything you’ve worked so hard for over the years. You could even wind up facing jail time, depending on the allegations. You may go to federal prison. Even after a short sentence, you could lose your license and find yourself unable to practice when you get out.

In short, these allegations can change your life. You need to know how to proceed. To start, take a look at these seven examples of Medicaid fraud to see how things stack up:

  1. Phantom billing: This means billing Medicaid for services allegedly given to patients, but the reality is that those patients have already passed away. Some experts call these individuals “phantom patients.”
  2. Excessive hours: In some cases, the billed hours actually exceed the workable hours in the day and clearly show that the care was not rendered in that manner.
  3. Unprovided services: This is simply the act of billing for services and goods that you never provided to patients. It could mean billing for something that did not happen at all or it could mean billing for additional services on top of legitimate ones.
  4. Fake credentials: You may use these as part of a cover-up effort, to hide other illegal services or to make it possible to bill for new services that did not occur. Remember, the cover-up often creates more problems than the initial action.
  5. Outside interests: This could mean that you own a related company, or that you at least have an ownership percentage, and then you cover it up to try to hide this conflict of interests.
  6. Kickbacks: In some cases, kickbacks are given out for specific services or medical goods, making their use more likely even if they should not be used or are not necessary in that situation.
  7. Double-billing: This just means billing for services and goods that never saw actual use. It could mean billing twice for similar services when they were only rendered once or, as noted above, billing for additional services on top of the actual ones provided to the patient.

All of these are just ways to excessively bill Medicaid and potentially commit fraud. If you face accusations that you did any of these things, you must think about your personal and professional future and learn all that you can about your legal defense options.