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Last Updated on: 26th July 2023, 10:03 pm
Medicaid fraud is when someone claims health care reimbursement from a Medicare program when they are not eligible. It is estimated that at least three percent of the Medicaid fund is fraudulently spent. The most common method of Medicaid fraud is failing to submit proper documents or submitting false ones. Some of the methods of document fraud include unreported assets, duplicate applications, unreported employment, or unreported income. Another form of fraud that is done by healthcare providers is phantom billing. The medical provider will bill for medical procedures and tests that were not needed or were not performed in this case. Patient billing is when the patient and the medical provider work together to defraud medicaid. The patient will be asked to lie so that they can share the proceeds between them.
Medicaid fraud is usually termed as a felony. This depends on the amount received and the context. The prison term could be increased if the accused has a prior criminal record. A felon loses the right to serve in a public office or to vote during elections. One could lose certain licenses including their visa. One can be deported if they are not US citizens and are found guilty of Medicaid fraud.
The fine that one will be ordered to pay is dependent on the violation and its severity. The fines range between five thousand and eleven thousand dollars per false claim if one violates the False Claims Act. This is a hefty fee. It is necessary because it discourages people from defrauding the government. Damages are also considered when the fine is being determined. It can be up to three times the amount that the government lost as a result of the false claims that were made in some cases. The Civil Monetary Payments Law caps the upper limit per violation to $50,000. There are assessments of up to three times the total amount that was claimed fraudulently for services and items.
The law allows anyone that has received overpayments to return the funds within sixty days. This means that one cannot argue that they did not have enough time to spot the error and return the payments. There are hefty fines. The first course of action is to determine whether the accused should be disbarred from health programs. One can lose the privilege of getting access to the program indefinitely if they are convicted. This is always the case if the violation is serious. This is done because one is considered to be a threat to the program and they have failed to show that they will act within the law.
One form of punishment is to reimburse the total amount of funds that one fraudulently received after a trial. The fines are usually set in place to help the government to recover the funds that they have lost. Restitution is applicable if the charges are not too serious and the amount is not that much.
The type of defense strategy is dependent on whether it is a civil case or a criminal one. The government looks for a monetary reimbursement from the accused in a civil case. One faces a criminal indictment with the possibility of imprisonment if it is a criminal case.
One must detach themselves from the involved parties in this type of defense. This can be done by presenting paper records and pieces of correspondence from the two parties. One can be dragged into these types of cases if the accused wants to lighten the burden by showing that they had an accomplice. This argument can be made when one is accused of patient billing. One must show that they were not involved in any way and that everything was done without their knowledge. This is important because the burden is on the defendant to prove that they had no part to play in the fraudulent activities.
Coding and Billing Errors
Billing changes occur every time. One can show that they were not aware of the change. This can be proved easily if the amount in question is minimal. An attorney can help you in such a case if they have an understanding of coding policies. Fraud charges can arise because there is an error in one of the documents. It could involve unreported assets that have not been documented well. The defendant must present accurate records that show the exact dates that ownership changed in this context.
This is applicable if one got employment after they had been enrolled in the program. The charges will be reduced if one is able to show that they are ready to return any funds that they received. Medicaid fraud charges are very serious accusations. One should make sure that they seek legal help immediately. The charges rack up huge fines and penalties. That is why they should not be taken lightly. One should seek an experienced Medicaid fraud defense attorney to help them fight the case.
Medicaid fraud is a heinous act where someone deceitfully claims healthcare reimbursement from a Medicaid program despite their ineligibility. It’s worth noting that an alarming three percent of Medicaid funds are lost to fraudulent activities. This article seeks to educate you on the various types of Medicaid fraud, the harsh penalties that await the culprits, and the defense strategies that can be employed when faced with such accusations.
The most prevalent form of Medicaid fraud hinges on the submission of inadequate or falsified documents. Fraudulent activities can involve unreported assets, duplicate applications, undisclosed employment, or concealed income. Healthcare providers are also guilty of committing fraud through phantom billing, where they bill for unnecessary or unperformed medical procedures and tests. Patient billing is another form of fraud, where both the patient and the medical provider collude to deceive Medicaid, sharing the spoils between themselves.
|Type of Penalty||Description|
|Prison Time||Usually considered a felony, the amount received and the context of Medicaid fraud determine the severity of the sentencing. An individual’s prison term may increase based on their existing criminal record. Convicted felons lose their right to vote or serve in public office and can potentially lose licenses, visas, or face deportation if they are not U.S. citizens.|
|Fines||Varying with the violation and its severity, fines can range between $5,000 and $11,000 per false claim under the False Claims Act. In some cases, damages can amount to three times the total government loss due to the false claims. The Civil Monetary Payments Law caps the upper limit per violation to $50,000 with assessments of up to three times the total amount fraudulently claimed for services and items.|
|Restitution||While fines are in place to facilitate the government’s retrieval of lost funds, restitution requires reimbursement of the exact amount received through fraudulent means. Restitution applies when charges are less severe and involve comparatively small amounts.|
|Disbarment from Health Programs||In cases of serious violations, convicted individuals can lose their privilege of access to Medicaid and other health programs indefinitely. This happens when someone is considered a threat to the program and fails to adhere to the law.|
Depending on whether a case is civil or criminal, various defense strategies can be employed. In civil cases, the government aims to receive monetary reimbursement, while criminal cases involve the possibility of imprisonment due to criminal indictments.
To defend against false accusations, it is crucial to distance oneself from the involved parties. This can be done by presenting paper records and correspondence that proves neither party had any connection to the fraudulent activities. Defendants in patient billing cases must demonstrate that they played no part in fraudulent activities and were entirely unaware of any wrongdoing.
As billing codes frequently change, one can argue that they were not aware of any alterations. This argument holds more weight if the disputed amount is insignificant. In such cases, an attorney with knowledge of coding policies can help defend the accused against fraud charges. Should an error occur in the documentation, such as unreported assets or changes in employment after program enrollment, the defendant must provide accurate records specifying the exact dates ownership changed.
Medicaid fraud charges are grave accusations, bringing with them staggering fines and life-altering penalties. Therefore, it is crucial to seek immediate legal help from an experienced Medicaid fraud defense attorney if faced with such allegations. With their support, defendants can effectively combat fraudulent charges, protecting their rights and future.
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