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.