Medicaid fraud is a crime that is taken very seriously in the United States, and statistics show that the rate of Medicaid fraud has been increasing alarmingly in many states, including in the state of New York. The Office of the Medicaid Inspector General is responsible for protecting the interest of the medical providers, taxpayers, and recipients of Medicaid. The Medicaid Inspector General is primarily responsible for catching the culprits behind the Medicaid fraud or who abuse the Medicaid program. There is a program in place in the state of New York that encourages the people to report any kind of abuse of Medicaid program they witness, notice, or come to know about. It helps the law enforcement agencies and other relevant authorities to take necessary actions against the offenders.
The benefits associated with Medicaid and its funds can be misused in various ways. It can be done by the medical provider as well as the patient, and such activities use up a lot of resources of the government, depriving the people of such benefits who are actually in need of it. Many different actions can lead to being named as Medicaid fraud, such as billing falsely for the purchase of equipment or medical services, which in actuality were never bought or availed in the first place, respectively.
When the people bill Medicaid for a doctor’s visit that never actually occurred, it amounts to Medicaid fraud. If the physician bills the patient and also the Medicaid, it is a textbook example of abuse of Medicaid program. If the doctor provides patients with the general medicine/drug but bills Medicaid for branded drugs, it amounts to Medicaid fraud as well. Making separate bills for different services instead of making one comprehensive bill and including expenses that are unrelated to Medicaid claims is also a kind of Medicaid fraud. If the doctor engages in up-billing, which means billing Medicaid for an expensive service than the one provided to the patient, it is a form of Medicaid abuse.
Those mentioned above are some of the examples of how the doctors engage in Medicaid fraud or abuse, and now let us look into how the patients can also abuse the Medicaid program. If the patients give their Medicaid card to someone else to avail Medicaid benefits, it is an abuse of Medicaid program. If the patients don’t report their actual income to the Medicaid, and if they are not eligible for the Medicaid, but continue to receive Medicaid benefits, it is a Medicaid fraud. If the patient’s health insurance provides adequate coverage for the illness yet, the patient fails to return the Medicaid benefits; it amounts to Medicaid fraud.
There are provisions in the law that can lead to incarceration for the people convicted of committed Medicaid fraud. In such situations, it is crucial that you consult an experienced New York Medicaid Fraud Criminal Attorney. A criminal attorney with specialized expertise and experience in handling Medicaid fraud lawsuits would be able to help defend you in the court of justice and ensure that incarceration is checked off the list of possibilities.
Medicaid runs a highly successful incentive program that encourages people to report any kind of suspicious activities they note that might be an instance of Medicaid fraud. People reporting Medicaid fraud can get close to $1,000 if the frauds they report are verified. People are rewarded under the incentive program when they report any suspected case of fraud related to Medicaid or if the reported fraud is validated as a potential fraud by other concerned authorities, including the Zone Program Integrity Contractor and the Medicare Drug Integrity Contractor. There are many different instances where reporting by people of any kind of Medicaid fraud can be rewarded. The idea here is to spread awareness of this highly present fraud being carried out in our society and to ensure that the taxpayer’s money is not misused.
People who have committed Medicaid fraud can be punished with penalties with an intensity corresponding to the seriousness of the fraud perpetrated. The defendant in Medicaid fraud can face up to few months to five years or even life imprisonment in jail, especially if it has caused physical injury or death of the patient. The defendant can also be given probation term during which he/she has to abide by all the probation guidelines, attend probation meetings, and meet the employment standards set for the probation period.
In many cases of Medicaid fraud, the defendants have to face the jail term as well as pay the fine or either of the one. In some of the cases, the fines can run into tens of thousands of dollars. The physicians charged with Medicaid fraud due to faulty administration may also face administrative sanctions. In some of the cases, the doctor’s license may also be canceled or they may be barred from participating in the Medicaid program. Hiring an experienced criminal attorney specializing in Medicaid fraud is an ideal solution to glide through the legal hassles when charged with Medicaid fraud or reporting its abuse with you as a victim.