What Constitutes Medicaid Fraud?
Among health law attorneys, there is a well-known Medicaid fraud legal case where the health care workers and suppliers exchanged funds and documents in a parking lot. While such activity raises the specter of suspicion, most Medicaid fraud cases are far less obvious.
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What is Medicaid Fraud
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Medicaid fraud occurs where health care providers, including doctors, hospitals and dentists, bill the government for payment of medical goods and services that were never delivered or provided. Basically, Medicaid fraud is theft of government money.
Billing for Services Not Rendered
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The most frequent form of Medicaid fraud is the billing of goods and services that were never provided at all. For example, a physician bills Medicaid for an appointment that never occurred.
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Billing for Exaggerated Services
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Another kind of Medicaid fraud occurs where there is billing for exaggerated services. For instance, a provider bills Medicaid for an hour appointment for a medical service such as physical therapy, but the appointment was actually only 30 minutes.
Billing for Non-Licensed Services Rendered
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Medicaid fraud also occurs where there is billing for physician services that were actually rendered by a non-licensed person. For instance, a bill is submitted to Medicaid which indicates that a patient was seen by a physician, while the patient was actually seen by an unlicensed person.
Kickbacks for Referrals
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A substantial area of Medicaid fraud is where a physician or other health care provider receives a kickback (a monetary or other gain of something valuable) for referring patients. For instance, a doctor refers all their patients to a certain X-ray facility and, in exchange for this, receives a trip to the Bahamas.
Excessive Co-Payments
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Finally, another area where there is Medicaid fraud is when a health care provider accepts co-payments from patients that exceed the required co-payment.
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