Medicaid fraud is an all too common crime that is committed and costs the government and tax payers billions of dollars each and every year. It was first introduced by the government in 1965 as part of existing social security legislation by the then President Lyndon B. Johnson and was devised to help low income/low asset people who need medical help. In 2010 the Kaiser Commission produced a report of Medicaid and the uninsured, and findings were that more than 29 million children along with 15 million adults are insured under the scheme. It is clearly a good system that allows people to be treated for illnesses and hospitalization without having to worry about the financial implications of their treatment. However for all the honest and needy people that benefit from Medicaid, there are thousands of unscrupulous people who abuse it.
Reporting Medicaid Fraud
Professionals who provide Medicaid services can be either one person, a collective group of people or indeed a health care facility, all of whom will supply medical services to Medicaid patients. Providers can include, but are not limited to, physicians, dentists, podiatrists, licensed professional counselors such as psychiatrists, medical equipment suppliers, ambulance companies, day clinics, nursing homes and case management centers. The usual case scenario is that when the professional has treated a Medicaid patient then they bill the state Medicaid program. However what often happens is that unscrupulous professionals or professional bodies will seek extra reimbursement for any or all of the following
- Billing for patients that don't exist, or other professionals patients
- Billing for services that they didn't actually provide
- Billing for testing or treatment that may have been deemed unnecessary
- Billing for any medical service that has been provided by an unlicensed person
- Over billing for supposed lengthy treatments which in reality, were over relatively quickly
- Making the Medicaid patient overpay for treatment that was part of the approved co-payment services
- Accepting bribes or kickbacks in return for referrals
Medicaid Fraud Whistleblowers
When it comes to Medicaid fraud reporting you could be eligible for a reward as a whistleblower. Each State has different criteria for this, but in essence it allows people with knowledge of suspected fraud carried out against the government to claim a share in the rewards. This is typically somewhere between 10% and 30% and when you consider that most frauds can run into millions of dollars, that could be a pretty large incentive to anyone who is thinking about it. In order to qualify for this incentive you have to need to meet certain criteria as follows:
- The case must not already be publicly known and you must be the original source of any information gleaned
- You must in no way have initiated or planned the fraud
- The information that you give must be relevant enough so as to bring about a successful conviction.
Like it or not, Medicaid fraud affects every one of us and in that respect everybody has a civic duty to report it. Contact one of our attorneys at 1-888-204-1014 if you think you have information about Medicaid fraud. We handle cases from all fifty States and you can call us toll free.
Medicaid Fraud Control Unit (MFCU)
It is very easy to assume that a little bit of fraud carried out by professionals who might be underpaid and underfunded against a government that can afford to lose a few dollars here and there, is doing no harm to you. That is incorrect. Medicaid fraud costs the government billions of dollars every year and in order to cover these losses the government may have to decrease other important government services or worse still, raise taxes. This in effect has a direct hit on your wallet.
The Medicaid Fraud Control Unit (MFCU) are funded by the state and try to police and track down unscrupulous practices, but they have their work cut out for them. This is why they also rely on people to report such behavior. However with this in mind, how would a person know that a professional body is acting in an unscrupulous way?
In essence many of the cases that are prosecuted by the MFCU often start with some information from a patient. So if any provider suggests treatments or services that you may not feel are necessary then be on your guard and be very wary. Also as a patient, be very wary of any organization offering free tests, free medical products or free services in exchange for information contained on your Medicaid card. If you are a family member of a Medicaid patient who is in a nursing home, check that they are physically okay and also keep a close eye on the elder patient's personal account and make sure everything is in order.
How Do You Report Medicaid Fraud?
The first thing you should do is to contact an attorney who understands the laws around Medicaid fraud. Once you’ve done this, you can contact the MFCU. In order for the Medicaid Fraud Control Unit to take your claim further they are going to need some information as follows:
- The name of the Medicaid patient and the assigned Medicaid number
- Who or what service administered the treatments and the alleged date/s
- A brief description of the treatments
- The name and contact details of the health care provider
Once you have this information, it makes things a lot easier. The next step is to contact your state's Medicaid office. You need to find the 'Program Integrity Division (PID) however it is worth noting that some states call this department a different name. If in doubt, just look up Medicaid or social services and contact them direct. Finally give them all the relevant information and they can look to take it from there.Medicaid Fraud Articles