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What are examples of provider and recipient Medicaid fraud?

On Behalf of | Aug 25, 2023 | Healthcare Fraud, Medicare / Medicaid Fraud

Committing Medicaid fraud is a severe crime that can impact the usage of public funds. This type of fraud can divert financial resources from vulnerable residents who rely on Medicaid for healthcare. Because of its significant impact on the community, authorities have anti-fraud initiatives to catch perpetrators and recover stolen funds.

Still, these investigations could rely heavily on reports of suspicious activity involving Medicaid benefits. They could categorize these incidents based on who committed the violation, the health care provider or the recipient. The following are examples of fraudulent activity potentially requiring law enforcement involvement:

Fraud committed by providers

These violations typically include schemes involving billing and other system procedures, such as:

  • Billing services not obtained by the recipient
  • Billing services that are inappropriate or unnecessary
  • Sale of prescriptions
  • Deliberate billing of treatment options that are more expensive than what was acquired by the recipient
  • Bribing patients with money or presents to have them provide consent to receiving medical services
  • Receiving kickbacks from referrals of patients

These offenses are unethical and could lead to severe penalties, including prison time, repayments and prohibition of Medicaid program participation.

Fraud committed by recipients

Some examples of recipient fraud could seem mundane but are, in truth, detrimental. They include the following:

  • Allowing others to use Medicaid identification cards
  • Changing or modifying prescriptions or fiscal orders
  • Using more than one Medicaid card
  • Receiving items from the Medicaid program and reselling them
  • Exchanging Medicaid cards or information with others

Whether intentional or not, these incidents could harm the public’s ability to access health care benefits for those in need. Fortunately, anyone can file a report for suspected Medicaid fraud.

Reporting Medicaid fraud can be scary

Reporting Medicaid fraud can be a scary task. Sometimes, the perpetrators can be people with authority at work or within the community.

If so, seeking legal counsel could be helpful. They can help determine the best way to report the incident and provide support throughout the process.