Last Updated on: 28th July 2023, 07:23 pm

In recent years, both local and federal governments have invested a great deal of time and resources for the prosecution and investigation of Medicaid fraud. In several states, staff and patients who file Whistleblower lawsuits regarding Medicaid fraud can be awarded up to thirty percent of whatever money is recovered. The problem is that this has caused a number of healthcare providers to be investigated because of small discrepancies and billing errors. A Medicaid fraud defense lawyer will help healthcare professionals and companies all over the United States.

Actions Taken Regarding Medicaid Fraud

If a provider is suspected of fraud, the company or the individual might face both civil and criminal charges for fraud. In many matters relating to health law, progression is slow; however, Medicaid fraud cases are the exception to the rule. There is a very fast progression to each fraud case, and improper handling can lead to devastating consequences.

In many cases, circumstances regarding Medicaid fraud are assigned to a special investigator or prosecutor. These officials have years of experience in abuse and fraud laws. This means that the retention of a fraud defense lawyer is essential for any healthcare provider.

These are the most common kinds of Medicaid fraud:

• False invoices
• Billing for services that were never provided
• Billing for equipment that was never provided
• Overutilizing certain services or medical procedures
• Billing services individually when they’re meant to be bundled

The most common consequences and sanctions that a provider might face are:

• Criminal fraud charges
• Expulsion from the Medicaid and Medicare programs
• Loss of medical license or other licensing action
• Loss of staff privileges or professional livelihood
• Ban from collecting any outstanding invoices
• Fines
• Monetary damages and reparations

Any Medicaid fraud audit has the possibility of evolving into a criminal indictment. It’s also possible that the provider will suffer professional licensing complaints along with civil recovery complaints. These can cause long term harm to a person, including large fines and time spent in prison. This is why it’s essential to have an attorney help supervise any Medicaid audit that you’re undergoing.

Medicaid Fraud Explained

Medicaid is a combination federal and state health insurance program that covers needy people and people with low incomes. The service covers uninsured children, the elderly, disabled people, blind people, and anyone who qualifies to receive an income maintenance payment from the federal government.

In thirty-two states, along with Washington D.C., Medicaid is eligible to people who are also eligible for SSI benefits. These states streamline the application by having the SSI benefit application and Medicaid application both be the same document. Medicaid coverage begins in the same month that SSI benefits do.

When a healthcare provider commits Medicaid fraud, this means that they have attempted to receive money or other compensation for services they did not provide. Most commonly, this involves doubly billing for only one procedure. However, fraud can also occur due to bills for services and equipment that were never used and unnecessary tests. The federal government has regulations regarding tests and procedures that must be bundled and billed together at a reduced rate. If a provider charges these procedures individually rather than bundling them, that’s another form of Medicaid fraud.

Though it’s good that people are being vigilant about saving Medicaid’s money, this vigilance can lead to consequences for innocent providers. For a provider to have committed fraud, their error must have been intentional rather than an unintended mistake. The burden is on the prosecution to prove that the error was intentional. A defense attorney can help explain errors and give the provider the best possible defense.

Accountability is an important factor in these proceedings. If a provider is willing to own up to their mistakes and repay any monetary damages, they’ll be less likely to face a serious fraud charge than a provider who fights to prove there was no error.