Medicaid fraud is a general term used that applies to any scheme that commits fraud against a healthcare insurance program. Fraud is defined as the misrepresentation of materials or services in order to gain certain benefits. In terms of healthcare, this misrepresentation is usually a claim sent to an insurance company, such as Medicaid, Medicare, UnitedHealthcare, Tricare, and more. When a claim gets submitted for services reimbursement that were either not conducted, overbilled, or not medically needed, the person or entity that caused this bill can be prosecuted for fraudulent behavior.
The most common Medicaid fraud examples include billing, falsification, kickbacks, and misrepresentation. A doctor that commits billing fraud may have not carried out the services or charged for more than what they performed. Furthermore, if a medical professional bills for a covered service when they had provided an uncovered service, or billed several times for one service, they are partaking in Medicaid fraud. Falsification can be related to altering certificates of what is medically necessary, providing a false diagnosis, or fabricating records or treatment plans to justify the Medicaid payments.
Moreover, invoicing services separately or forging receipts that should be considered single-service fees constitutes fraud. A healthcare provider may engage in Medicaid fraud if they are not forthcoming about diagnoses, treatments, testing, or medicines when seeking payments. Or as the team from Morales Law Firm is well aware, a healthcare provider may diagnose and prescribe the patient items that are not medically necessary, or intended for use by people aside from the patient. Kickbacks entail any form of compensation that prompts a medical provider to refer patients, coax a patient to utilize a medical practice, or accept kickbacks for referral of patients.
There are signs to watch out for that mean you could be under investigation for Medicaid fraud. You may receive a grand jury target letter or search warrant, to be used against you or your medical practice. You may also get a letter from a federal prosecutor or Department of Justice, claiming that you are a witness or subject to a Medicaid fraud federal investigation. If this happens, it means prosecutors are looking to indict you and/or your healthcare practice, but they don’t have sufficient evidence to show a grand jury yet. You may be under investigation for fraud if you learn that your patients, employees, or other witnesses are being interrogated or surveillanced. If you are receiving an increase in audits and record requests from Medicaid, then you may be under the spotlight and suspected of fraud.
As a medicare fraud lawyer San Francisco, CA residents confide in at Morales Law Firm can attest, based on the circumstances of the case, you may be able to avoid criminal charges from being filed, have the case dismissed, or avoid overpayment or licensing actions. If there is evidence being used against you, a dedicated legal team can work to find you a favorable settlement that has minimal impact on your future.