Medicaid fraud occurs when an individual or provider intentionally gives incorrect information so that Medicaid pays for certain medical services, whether existent or non-existent.
There are no exact statistics when it comes to Medicaid fraud. However, reports show that fraudsters cause the Medicaid Program billions of dollars. Consequently, they put the welfare and health of beneficiaries at risk. Anyone can commit this fraud. The schemes can be perpetrated by an individual or a group, including organized crime groups.
The most known type of Medicaid fraud is where individuals steal people’s medical identity and use it to obtain medical services, goods, or even obtain payment from Medicaid. However, there are other ways that individuals defraud Medicaid. Medicaid fraud can be divided into three broad categories, i.e., fraud brought about by the provider, fraud brought about by the patient, and fraud brought about by the insurer.
This is a major area of Medicare fraud by providers. It happens when a medical provider bills for services they have not provided. For example, the provider can bill for x-rays when they did not take any or bill for blood tests when they did not draw any blood from the patient.
Some providers prescribe unnecessary procedures or tests just so that they can get paid for the same.
Double billing happens when a provider bills both Medicaid and a private insurance company.
Since generic drugs are cheaper than brand prescriptions, some providers give patients the generic drugs but bill the amount of branded prescriptions.
Some providers exaggerate the kind of service they give the patient. For example, a doctor can bill a patient for a one-hour session when he only sees them for 15 minutes.
In an attempt to stop Medicaid fraud, the government introduced several programs. However, enforcement has proved to be difficult due to a large number of Medicaid providers and beneficiaries.
Therefore, there is a need for people to take a personal initiative to prevent Medicaid fraud. Here are a few ways you can prevent this fraud:
The government is conducting thorough background checks before admitting individuals to the Medicaid program. Additionally, the government has invested in sophisticated technology that can flag suspicious patterns and ensure that only the rightful beneficiaries get services.
If you are trying to track down perpetrators of Medicaid fraud, contact us today to start your free trial.