Medicaid is a federal and state health coverage
program that provides health care to people who are unable to pay for it
themselves. It is offered free of charge to certain individuals and families, granted
they meet the eligibility requirements.
There are usually two parties who are involved with
receiving Medicaid; recipients and providers. Recipients pertain to individuals
or families who are receiving Medicaid benefits. Providers pertain to individuals
or companies that are paid by the Medicaid program, including doctors,
dentists, pharmacies, clinics, hospitals, etc.
Usually, Medicaid Fraud investigations for either
party occur when the investigator suspects that you have been lying or failed
to disclose important information.
The top reasons behind Medicaid Fraud investigations
against recipients include but are
not limited to:
1. Falsification
of information
The eligibility requirements for the Medicaid
program are strict. If you lie or provide false information that does not match
records and documents, it is likely that you will be targeted by investigators.
2. Failing to
disclose important information regarding income and/or assets
Attempting to hide any information will also raise
an issue with investigators. You can’t lie or hide documented information.
3. Failing to
update the program on any changes regarding income/assets/relevant eligibility
circumstances
Any changes that are related to Medicaid eligibility
should be reported to the agency immediately or else it will be considered
fraud. Changes in income, living situation, or any information that is
considered by the program should be reported.
4. Abuse of
Benefits
Some examples of abusing Medicaid benefits include;
altering, forging, or obtaining duplicate prescriptions, re-selling medicine or
products obtained through the program, and more.
5. Cheating
with Medicaid cards
If you allow another person to use your Medicaid
card or use more than one Medicaid card, you are committing fraud.
The top reasons behind Medicaid Fraud investigations
against providers include but are not
limited to:
1. Cheating
the billing system
Ultimately, this is one of the most common issues
that usually result in Medicaid fraud because there are numerous ways that
providers cheat the billing system. Billing for services not provided, billing
for fake or non-existent medical conditions, billing for services that were not
medically necessary, and other scenarios all fall under this common reason for
Medicaid Fraud investigation.
2. Misrepresentation
of provided services
Some examples include billing for more expensive
services than actually rendered, billing twice for the same service, billing
separately for services that should be billed together, dispensing generic
drugs while billing for more expensive brand-name drugs.
3. Falsifying
information
This includes submitting false time records,
signatures, or price reports, prescribing or filling fraudulent prescriptions,
and more.
4. Bribery
Some providers may choose to give or receive
something in return for medical services or referrals.
5. Violation
of Medicaid rules
This includes: billing for services provided by
unlicensed or uncertified personnel, billing for services provided by someone
on a Medicaid exclusion list, and more.
Regardless of whichever party you pertain to or the
reasons for investigation against you, do not try to handle this situation on
your own. By the time you receive notice of Medicaid Fraud investigation, the
investigator has gathered evidence against you and you will likely need the
assistance of an attorney.
Contact an experienced Medicaid Fraud Attorney
immediately. Attorney Inna Fershteyn has years of experience regarding Medicaid
Fraud investigations and can help you by negotiating a settlement that reduces
or eliminates penalties and interest – and, most importantly, by negotiating an
agreement that your case will not be referred for criminal prosecution. To
arrange a confidential consultation, call at (718) 333-2394 or ask your
questions at www.BrooklynTrustAndWill.com
Law Office of
Inna Fershteyn and Associates, P.C.
(718) 333-2394
1517 Voorhies Avenue, Suite 4
Brooklyn, NY 11235
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