Understanding the types of Medicaid fraud

On Behalf of | Aug 9, 2021 | Health Care Fraud

Medicaid and other types of health care fraud are on the rise in New York City and around the country. If you have been charged with health care fraud, you could face considerable penalties including fines and imprisonment. Understanding health care fraud is a key step in preventing it.

What is health care fraud?

Health care fraud includes fraud by medical practitioners and that by patients or beneficiaries. This includes knowingly giving false information in order for Medicaid to cover health care services.

Types of health care fraud

Some self-explanatory types of health care fraud committed by providers include billing for unnecessary medical items or services and billing for medical items or services that were never provided. Unbundling services that are typically covered together and upcoding less-complex services for more-complex ones are other types of provider fraud.

Health care fraud committed by both beneficiaries and providers can include collision, which involves falsifying information in conjunction with your doctor to receive or bill for unneeded services. Drug diversion is a type of fraud in which medical care providers write additional prescriptions for personal use or to sell themselves. Drug diversion also includes a beneficiary altering a prescription or visiting more than one doctor for the same prescription.

Card sharing involves a doctor knowingly accepting a card from someone who is not the beneficiary or the beneficiary giving their card to someone else so they can get medical services. Additionally, providers or doctors who offer kickbacks or solicit beneficiary referrals are considered health care fraud.

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