We recently discussed major types of Medicare fraud, which include unnecessary tests, billing for services that weren’t provided or overbilling for services to inflate the costs. These are all things that a whistleblower may want to be aware of because they can report this type of fraud and abuse if they see it happening.
But the Medicaid system is different. Medicare focuses on those who are 65 years old and older, and it sometimes applies to those with disabilities. Medicaid, on the other hand, focuses more on those who have limited income but still need health coverage. So both programs can help to provide services and cover costs, but they do so for different groups of individuals. Is the fraud that you will see in Medicaid similar to that you would find in Medicare?
There are many of the same issues
Yes, although there are a multitude of different types of Medicaid fraud to consider, some of them are very similar. Billing for unnecessary services is still an issue, as is overbilling—often done through upcoding, when cheaper services are offered but then codes for more expensive and more complex services are used.
Other forms of Medicaid fraud
But there are some other types of fraud to consider as well, including collusion or kickbacks. This can happen when providers receive a financial benefit for prescribing certain medications or treatments. Another type of fraud involves using multiple Medicaid ID cards. If someone knowingly does this just so that they can be reimbursed for more services, it can be a serious type of financial fraud.
In all of these cases and more, whistleblowers need to know exactly what steps they can take. They should also be aware of their legal protections when moving forward with their report.