Medicaid is the federal government’s insurance program for the poor. Medicaid fraud is a serious crime, costing the government billions of dollars every year. There are a few different ways Medicaid fraud can be perpetrated.
Doctors and other medical practitioners
Doctors and other medical practitioners can commit Medicaid fraud in a number of ways. They might bill for extra procedures they didn’t perform, purposely miscode procedures to get paid more, bill for expensive tests and procedures that aren’t necessary, double bill both Medicaid and a private insurer and bill for patients they didn’t see at all or use fake names and Social Security numbers to bill for patients who don’t qualify for Medicaid.
Pharmacies and vendors of other medical products are another source of Medicaid fraud. A common scam by pharmacies is billing Medicaid for the cost of a brand-name drug, while giving the patient a generic drug. Ambulance companies sometimes bill Medicaid for trips that aren’t necessary, such as taking an elderly patient to a doctor’s appointment. A nursing home might bill Medicaid for personal expenses that it’s not allowed to cover. Many businesses also offer and receive kickbacks — bribes for referring a patient to a provider — a practice that is forbidden under the law.
Patients also commit Medicaid fraud, although they generally get a lot less benefit for it. One of the most common patient frauds is continuing to receive Medicaid coverage after they are no longer eligible. Patients also work in concert with doctors to bill for fake injuries and ailments.
Anyone charged with Medicaid fraud definitely needs a medicaid fraud lawyer.