Medicaid Fraud

Medicaid fraud has cost the federal government hundreds of millions of dollars over past few years. As a result, authorities are cracking down harder than ever on cases of potential Medicaid fraud. Providers who are implicated in being involved in any kind of Medicaid fraud can expect for their practices to go under the microscope. From overbilling and upcoding to phantom billing and kickbacks, there are a variety of different situations that can fall under the umbrella of Medicaid fraud. If you’ve been charged with any type of Medicaid fraud, your business and freedom are on the line. Contact a skilled criminal defense lawyer with proven white-collar criminal defense experience as soon as possible. Listed below are some common types of Medicaid fraud.

Common Types of Medicaid Fraud

Upcoding

Upcoding is a popular form of Medicaid fraud. This type of fraud occurs when certain procedures are billed as more expensive procedures than what actually took place. Unfortunately, the Medicaid billing and coding systems are very complex and involve a vast quantity of codes. A perfectly innocent billing error shouldn’t land you in prison. If you’re facing charges related to upcoding and Medicaid fraud, you need to contact a criminal defense attorney immediately. 

Unbundling

When certain procedures of a similar nature are done together, there are often bundled codes and rates. In most cases, these bundled codes result in lower prices. Unbundling happens when those procedures are separated out for billing purposes. Each procedure is coded and billed separately which jacks up the overall price. 

Phantom Billing

Phantom billing, or fraudulent billing, is a type of Medicaid fraud that happens when a claim billing form is submitted, but no services were ever rendered. Essentially this type of fraud happens when services are billed, even though they never happened. If a claim form is submitted for a procedure that never happened, that’s considered phantom billing. Allegations of phantom or fraudulent billing can land you in hot water, so the sooner you speak with a criminal defense attorney with proven Medicaid fraud case experience, the better chance you will have at a favorable outcome in your case. .

Unnecessary Services

Another common type of Medicaid fraud is when providers engage in unnecessary services. Services and procedures have to be necessary in order to meet Medicaid billing standards. If you can’t justify a service as being necessary, but you submit it as a Medicaid claim, you could be face Medicaid fraud charges.

Kickbacks

Another one of the most commonly seen forms of Medicaid fraud is the accepting of kickbacks. A kickback is a secret payment between providers and other people in the medical profession. It can be between pharmaceutical companies, medical device manufacturers or other healthcare providers. This hidden payment is in exchange for using the other provider’s goods or services in efforts to increase monetary gain.

Penalties Associated with a Medicaid Fraud Conviction

Medicaid fraud is a very serious set of crimes. The federal government takes any allegations of Medicaid fraud very seriously and investigates to the fullest extent of the law. If you’re facing Medicaid fraud charges, your whole practice will be under extreme scrutiny. If convicted, you can expect to spend no less than five years in a federal correctional facility. Additionally, the fees and fines associated with Medicaid fraud cases are astronomical. It’s possible to owe up to one million dollars or more, if convicted. Not only do you have to pay your debt to society through prison time and fines, you will also be likely to lose your professional licenses and ability to make a living once you get out.