Unfortunately, Medicaid/Medicare fraud and abuse is a very real problem in the United Sates. In fact, according to the National Conference of State Legislatures, this type of fraud costs the United States billions of dollars each year and threatens the very services that these programs aim to provide. Understandably, then, there are many efforts being made to combat this type of fraud and abuse among healthcare providers.
There are many different types of actions that can constitute Medicaid fraud, including:
- Billing for unbundled services
- Billing for equipment that was never provided
- Billing for services that were never provided
- False invoicing
- Excessive/improper use of specific medical services or procedures
- Prescribing medicines that are not medically necessary
- Accepting “kickbacks” for patient referrals
- Falsifying a diagnosis
- Billing more than once for the same service
Generally speaking, Medicaid fraud refers to the use of any illegal actions to collect Medicaid funds. When Medicaid fraud is suspected, an audit is typically performed. These are usually carried out by state agencies using many different actions ranging from data mining to detailed records review.
From there, if fraud is believed to have occurred and is provable in court, a criminal indictment will likely take place. Fines and penalties may be charged, and depending on the nature of the alleged fraud, the audit team may even choose to go after the healthcare provider’s medical license or other credentials.