Why It Is In Your Interests To Report Medicaid Fraud

Medical cover has been one of the fastest growing items on many state budgets in the past few years as Medicaid fraud continues to cost the government billions of dollars each year. The bill continues to rise as unscrupulous doctors bill for hours of procedures which were never carried out, pharmacists submit prescriptions for deceased patients, phony companies invoice for non existent services, and health care homes invoice for the care of elderly patients that are actually in hospital. More cheating is being uncovered as scam artists have discovered that years of a poorly managed system, have made Medicaid an easy target for plundering.

Medicaid was set up to help those on low incomes

First set up in 1965, Medicaid is a federal/state cost sharing health insurance program providing health cover for people on low incomes including elderly people, families with children, disabled people, foster care, pregnant women, and low income people suffering from specific diseases such as HIV/AIDS, tuberculosis, and breast cancer.

Medicaid is quite clearly a good system since it saves a large number of people from worrying about the financial implications should they become ill or need hospitalization. However for all the honest and needy people who benefit from the system there are thousands of unscrupulous people who benefit from Medicaid fraud and not only is this a constant source of worry for the government but it is causing anger amongst millions of taxpayers who are faced with footing the bill.

What is Medicaid provider fraud?

Medicaid providers are people such as doctors, hospitals, dentists, pharmacies, clinics, and home care companies that are paid by the Medicaid program. If a provider intentionally misinterprets services or goods supplied and receives reimbursement for them, then provider fraud has been committed.

Medicaid fraud is carried out by providers in various ways including:

• Phantom billing - billing for medical services that were never performed
• Billing for several services individually whereas they should have been grouped into one item at a lesser charge
• Billing twice for the same service
• Billing for brand name drugs and giving out generic drugs
• Billing for a more expensive service than that which was given - also known as upcoding
• Accepting kickbacks - giving or accepting something in return for medical services
• Bribery
• False reports of costs
• Embezzlement of funds received

How does Medicaid fraud affect me?

Each time a provider puts in some sort of false claim to steal money from the State program, it reduces the amount of resources available within that program. It can reduce the quality of the treatment as unscrupulous providers try to reduce costs for their own personal gain. To compensate for this fraud, the state either has to decrease services in another sector or it has to raise its taxes.

How to Report Medicaid fraud

All the states have their over Medicaid programs which differ slightly but they all have one thing in common which is that they are only too pleased to have members of the public report on any fraudulent acts against the government. Known as 'whistleblowers' these individuals may be entitled to claim a share of the rewards should a lawsuit be successful. This is generally between 10-30% of the overall sum, which considered that most frauds run into millions of dollars, is a tidy sum of money to receive for having done the right thing. There are certain criteria in order to qualify for this incentive:

• You must be the original source of the information and it must not already be known
• You must not have initiated or planned the fraud
• The information you volunteer must have substantial grounding to bring about a successful conviction

If you are fairly certain that you alone have knowledge of a past or current Medicaid fraud then the first thing to do is to contact a team of attorneys who can ascertain whether there is a case to answer and help you file a suit.