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What signs of Medicaid fraud should providers look out for?

On Behalf of | Dec 7, 2023 | Medicare / Medicaid Fraud

Medicaid fraud is a severe issue in New York, costing the state valuable resources that could have been allocated for other urgent needs. This type of fraud can involve one or more parties, including patients, health care providers and practitioners. If left unresolved, these activities can impact the state’s fiscal health and harm those genuinely in need of Medicaid coverage.

Due to its detrimental effects on healthcare quality, providers should know how to spot Medicaid fraud. Watching out for the following incidents can help detect and address them immediately:

  • Orders and bills for services not needed by the patient
  • Unreconcilable services billed but never received by the patient
  • Billing costlier medical options even if the patient received a different service
  • Deliberately sending multiple bills for the same medical service
  • Medicaid providers showing preference by giving cash or valuable gifts for referrals
  • Fraudulent activities involving prescriptions, such as forgery or unauthorized selling of prescribed medication

These practices can endanger providers and their patients. It is best to point out inconsistencies that can signal Medicaid fraud. Sometimes, these signs can be honest errors in the system, but they should still be worth resolving to maintain the provider’s quality of care.

Empowering the medical industry against Medicaid fraud

Healthcare providers, medical practitioners and other staff members often have active roles in addressing Medicaid fraud. With their knowledge of healthcare processes and patient care, these parties are in ideal positions to spot irregularities that may indicate fraud.

Additionally, facilities should have an environment that encourages vigilance and transparency. These measures might not remove the risk of Medicaid fraud, but they can help identify and report them appropriately.