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Who Can Be Charged With Medicaid Fraud?

Medicaid fraud, regardless of who perpetrates the fraud, is misrepresenting information to obtain a benefit from Medicaid. Both the state and federal government have programs to identify and prosecute Medicaid fraud, although, currently, the emphasis is on fraud prevention. Because fraud cost the Medicaid billions of dollars each year, these programs have become sophisticated; New York routinely checks DMV records, bank accounts and other data to discover potential fraud. Whistleblowers also receive money for reporting Medicaid fraud. Everyone who participates, in any way, in the Medicaid program may be charged with fraud, including:

Recipient Fraud

The most common way individuals defraud the Medicaid system is by providing false information on their application or renewal applications, such as not reporting employment or assets. This includes falsifying supporting documents and not being truthful about the number of people in a household. People who obtain medications or home health equipment under false pretenses, for example, by lying to a physician, so he or she can sell the medication or equipment, is also committing fraud.

Provider Fraud

Physicians and other healthcare professionals who receive payments from Medicaid may be charged with fraud if they bill for a procedure that they did not perform or they bill Medicaid for a covered treatment when they actually performed a treatment that is not covered. Kickback schemes are considered fraud as well, even though in many businesses it is common practice to reward people who refer others to a business.

What happens to People Convicted of Medicaid Fraud?

Medicare fraud investigations, if wrongdoing is found, may result in a civil lawsuit or a criminal case. Anyone who receives a letter or a visit announcing that they are under investigation should consult an attorney specializing Medicaid fraud representation.

For more information, see medicaid fraud lawyer.