It’s pretty crucial that you hire a Medicaid fraud attorney if you’ve received a notice accusing you of Medicaid fraud.
Medicaid fraud seems to be occurring a lot more now than ever. And not just on the recipient’s behalf either, as more and more cases of provider fraud are being investigated. So if you find yourself on either side of Medicaid fraud allegations, do yourself a favor and hire a Medicaid fraud attorney.
What is it?
A Medicaid fraud lawyer is an attorney that specializes in specific state laws as they pertain to Medicaid, which is the government program that provides medical aid to the poor. Of course, a noble program like Medicaid is vulnerable to those that will take advantage of either the services or the government funding (we’re talking about your tax dollars, folks). That being said, possible offenders can exist on both sides, as recipients and providers will sometimes bend the rules to their favor.
But what constitutes as Medicaid fraud? Though it may vary from state to state, common examples of Medicaid recipient fraud (those receiving medical aid) are: stating false facts on your Medicaid application form; loaning Medicaid to another person; forging or altering a prescription; using more than one Medicaid card; and reselling items you’ve received through Medicaid.
On the other side of the coin is Medicaid provider fraud, which targets fraudulent acts on behalf of individuals or companies receiving funds from the Medicaid program. In other words, providers would include doctors, dentists, hospitals, nursing homes, pharmacies, clinics, counselors, and personal care or homemaker chore companies. Common examples of Medicaid provider fraud would be: billing for services that were never provided; duplicate billing (billing Medicaid, as well as private insurance); providing unnecessary services; upcoding (billing for a comprehensive visit when only a simple office visit took place); and providing false cost reports.
The Health Department’s Office of Medicaid Management employs watchdogs and investigators who will keep an eye out for fraudulent behavior as well as review recipient use of Medicaid benefits. In some cases, recipient fraud may be transferred over from the Health Department to other government authorities, such as Criminal Court. Of course, any average citizen can qualify as a Medicaid fraud whistleblower. In fact, some states offer cash incentives for such information.
Who needs it?
First and foremost, the Health Department’s Office of Medicaid Management is comprised of good, hardworking people (remember, they’re always watching us). But some of their leads and information can be inaccurate from time to time. Therefore, along with those that are guilty of Medicaid fraud, are those that are completely innocent though they have been charged with accusations suggesting foul play. Furthermore, there are those that have made unintentional mistakes that unfortunately constitute as Medicaid fraud. Whatever your case may be, if you have been charged with Medicaid fraud (recipient or provider), you should hire a lawyer specializing in Medicaid fraud immediately because conviction could result in the souring of a person’s career, livelihood, and reputation.
