What is Medicaid fraud?
Put simply, it is the misuse of federal Medicaid funds and benefits. This can be committed by either the patient or the medical provider/facility. A wide variety of actions can constitute fraud.
For providers, fraudulent actions include:
- Phantom billing – billing Medicaid for a visit that did not take place.
- Falsifying claims – billing Medicaid for services that were not performed or equipment that was unnecessary.
- Double billing – billing both Medicaid and the patient (or another insurance company) for the same service.
- Kickbacks – receiving kickbacks, bribes or other forms of compensation for referring patients to other facilities or providers.
- Drug substitution – billing Medicaid for a brand name drug, yet providing the patient with a generic.
- Falsifying expense reports – including personal or unrelated expenses on Medicaid claims.
- Unbundling – billing for services separately when they should be combined.
- Upbilling – billing for a more expensive service than the one actually delivered.
For patients, Medicaid fraud can include:
- allowing a non-Medicaid participant use their Medicaid card to get benefits;
- forging prescriptions;
- failing to reimburse Medicaid when health insurance provides coverage; and
- failing to report sources of income or inheritance.
Penalties for Medicaid Fraud
Penalties can be severe, so those facing charges of fraud in the healthcare system should speak with a Fort Lauderdale fraud attorney.
Penalties for can include:
- Jail time – this can be anywhere from five years to life in prison, depending on the severity of the fraud and whether it resulted in bodily injury or death of a patient.
- Fines – depending on the exact charges, anyone facing fraud of the healthcare system could be charged with fines of tens of thousands of dollars or more.
- Probation – those convicted may be put on probation. During this time, they must abide by all probationary requirements, including regularly attending probation meetings, employment standards and more.
- Restitution – if the fraud resulted in a loss of funds for an insurance company or patient, they may be ordered to pay restitution to the victim, essentially reimbursing them for the money lost.
The exact penalties a defendant may face depend on the specifics of the case and how the defendant committed fraud against the healthcare system. Anyone facing these charges should contact a Fort Lauderdale fraud attorney for a full evaluation of any consequences that may be expected.
Help from a Fort Lauderdale Fraud Attorney When Facing Charges
Medicaid fraud is a serious charge with serious penalties. Medical professionals and patients facing these charges should contact an attorney as soon as possible to begin building their defense against charges of fraud in the healthcare system. Those facing Medicaid fraud charges can call 888-744-8225 to speak to a Fort Lauderdale fraud attorney at the Law Offices of Robert David Malove.