If you, a medical services provider, are being investigated for Medicaid Fraud please take a minute to review some of the reasons for worrying:
Medicaid providers include doctors, dentists, hospitals, nursing homes, pharmacies, clinics, counselors, personal care/homemaker chore companies, and any other individual or company that is paid by the Medicaid program.
If it can be proved or alleged that a provider intentionally misrepresented the services rendered, and therefore increased their reimbursement from any State’s Medicaid, provider fraud may have occurred resulting in charges being filed against a target Defendant(the medicaid services provider). Simple accounting mistakes may be blown out of proportion resulting in charges being filed by the white collar division of the local prosecutor’s office.
Do not delay in obtaining legal counsel: i.e. lawyering up!
What are some examples of Medicaid provider fraud?
- Billing for medical services not actually performed, known as phantom billing;
- Billing for a more expensive service than was actually rendered, known as upcoding;
- Billing for several services that should be combined into one billing, known as unbundling;
- Billing twice for the same medical service;
- Dispensing generic drugs and billing for brand-name drugs;
- Giving or accepting something in return for medical services, known as a kickback;
- Providing unnecessary services;
- False cost reports; and
- Embezzlement of recipient funds.