Medicaid Fraud

Medicaid fraud has a lot of victims. But these are not the recipients of the program, but taxpayers from whom general funding for Medicaid is sourced from. Avoiding Medicaid fraud is not a question of preventing a person from being a victim due to the very nature of the program, but rather stopping them from being a perpetrator.

The Medicaid program is controlled in the United States under Title 19 of the US Code. In some cases it is actually called Title 19 instead of Medicaid and the terminologies are interchangeable. Even though it may be possible to steal someone’s identity in order to get Medicaid benefits, this is very rare and can be prevented by following tips and advice to avoid being victims of identity theft.

Medicaid may seem like a very good idea for those who are not insured or who are suffering under the difficulty of high health insurance premiums. But since there are income guidelines and other qualification criteria in place, this only allows certain people to get hold of benefits from the Medicaid program. Those who are left out or do not qualify may be tempted to enter Medicaid fraud.

Medicaid fraud can be the product of one of two scenarios. The first one involves those who misrepresent themselves when applying for Medicaid in order to get hold of benefits such as health coverage. The second scenario comprises of healthcare providers who may present false claims in order for them to collect unearned payments from the Medicaid system.

Those who commit Medicaid fraud may not report all of their income. They may also report more dependents than they truly have or make other false statements to make their income to liabilities ratio dismal. Those who carry out Medicaid fraud know which details a social worker can easily verify and which are harder. In order to avoid being accused of Medicaid fraud, those applying should be very honest and take their time to completely fill out the forms as required.

Healthcare providers submitting claims for procedures or work not done is another type of Medicaid fraud. This is also practiced in the Medicare program and even private insurance. This type of scam may be hard to catch, specially if the patient is part of the scheme. To avoid being accused of this type of fraud, doctors should document any procedure done very carefully. Added protection would be to have a nurse, physician’s assistant, or another partner sign off on any work done.

Medicare fraud involves serious fees and penalties, and investigations into diagnosed cases are pursued by many federal and state agencies like the FBI, Department of Health and Human Services and Department of Justice. Health care providers found guilty of Medicaid fraud are responsible under the False Statements Act, 18 U.S.C. §1001. Punishment for this Act is a fine not above $10,000 or an imprisonment of up to 5 years. Both charges could be combined based on the severity of the criminal prosecution.

State governments encounter the horrible reality that the Medicaid program has become too big and difficult to manage easily, despite having tougher enforcement. With growth rates predicted in the near future, reducing theft, waste, or quick errors in Medicaid can get harder.