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What are examples of Medicaid fraud?

On Behalf of | Apr 2, 2024 | Medicare / Medicaid Fraud

One reason why whistleblowers decide to speak out is when they see evidence of Medicare or Medicaid fraud. These are government benefits systems that can cover the cost of certain medical treatments. Because Medicaid can be billed for those treatments, there are those who seek to use this for their own financial gain.

Whistleblowers may decide to speak out, but what type of fraud could they be looking for? Below are a few examples – although this is not an exhaustive list – of what Medicaid fraud could look like today.

Double billing

One example is when the provider bills Medicaid twice. It’s the same treatment, but they try to get compensation for that treatment repeatedly, defrauding the system.

Using generic drugs

Many prescription medications have generic drugs that can be used in their place. These are often much less expensive. So one form of fraud could be claiming that name-brand medications were provided when the generic alternatives were actually substituted.

Taking kickbacks

In some cases, Medicaid fraud involves kickbacks, which is when a third-party provides financial compensation to a medical provider. For instance, a medical provider could send someone to get lab tests that they don’t need because that provider gets kickbacks from the lab.

Billing for services that weren’t provided

Finally, fraud often occurs when services aren’t rendered but Medicaid is billed anyway. Patients may not even come to the office, but Medicaid could be billed as if they needed extensive treatment. 

Are you considering being a whistleblower over something like Medicaid fraud? Be sure you know exactly what protections you have and what legal steps to take.