Defending Charges of Medicaid Fraud
Millions of dollars are lost every year to Medicaid fraud. It is a crime involving misrepresenting facts or providing false information in order to get Medicaid payments. This occurs when organizations bill Medicaid for services never provided, make coding changes to charge for more expensive services, or get kickbacks. The crimes are costly, and charges could result in serious consequences.
Examples of Medicaid Fraud
Medicaid fraud occurs in a variety of ways. Knowingly defrauding any health care benefit program violates federal statute. In fact, the act of deliberately ignoring the truth in these matters can land someone in deep trouble, as well. The following crimes occur most commonly:
- Submitting claims to Medicaid for goods, procedures, or services that the patient did not actually need or did not receive;
- Performing a service, but billing for a more expensive procedure;
- Billing two entities for the same service (such as Medicaid and the patient or another insurance company);
- Receiving money in exchange for referrals;
- Providing false information in order to participate in Medicaid;
- Neglecting to adequately medically screen patients who are in labor or experiencing another emergency in a hospital emergency room;
- Supplying misleading or outright false information in anticipation of influencing discharge decisions;
- Failing to report and return erroneous overpayments from Medicaid within 60 days of discovering the issue;
- Billing separately for services that should be combined into one price;
- Misappropriating health care providers’ medical identifiers;
- Buying or selling Medicaid numbers;
- Obtaining medical services or funds using someone else’s Medicaid name and number.
Penalties for Medicaid Fraud
Anyone who is facing charges of Medicaid fraud is looking at substantial penalties
- Being put on the Office of Inspector General’s exclusion list, which means they will never be allowed to work with any federal government health care programs, including both Medicaid and Medicare. For a nurse or physician, that could be career-ending;
- A likelihood the state medical board will suspend or revoke one’s professional license, a serious problem for pharmacists, nurses, physicians, and others;
- Assets linked to the crime, from bank accounts to vehicles and other property, may be seized;
- Civil penalties: Fines of up to $27,000 per infraction in addition to triple the loss to the Medicaid program;
- Criminal fines can be in the hundreds of thousands of dollars;
- Imprisonment for as much as ten years per count.
Fighting for You
The experienced Las Vegas criminal defense attorneys at Lobo Law appreciate the seriousness of these charges and understand just how devastating a conviction can be. We will fight to safeguard your rights and to achieve the best possible outcomes. To discuss, schedule a confidential consultation in our Las Vegas office today.
Source:
ag.nv.gov/About/Criminal_Justice/Medicaid_Fraud/Crime_Types/
