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What Is Medicaid Fraud?

Medicaid is a program that is jointly funded by state and federal governments and provides health care to millions of Americans, including low-income families, children, and elderly adults. When a medical professional provides services to a Medicaid beneficiary, they bill the program for expenses. Unfortunately, some health care providers, for a number of reasons, such as overlooking patient records, might request reimbursement for services that weren’t provided. This type of conduct is what is known as Medicaid, or healthcare, fraud.

Billing practices that defraud Medicaid can result in billions of dollars in annual losses. Because this can cause a strain on resources for people who rely on the program, state and federal governments aggressively pursue these matters. Every state has a Medicaid Fraud Control Unit (MCFU) that investigates these cases. The MCFUs work with investigators, attorneys, and auditors to identify instances of fraud and file charges against the accused.

Recent Cases of Health Care Fraud

In September of 2019, the Department of Justice announced that it had charged 26 people allegedly engaged in Medicaid and Medicare fraud schemes. Those charged included doctors and medical professionals who are claimed to have cost taxpayers $257 million.

Earlier this year, the Colorado Attorney General’s Office said that it had filed felony theft and computer crime charges against the owner of a children’s dentist office who allegedly bilked Medicaid out of $400,000. He is said to have billed the program for services performed by dentists who were no longer working at the office at the time the information was filed.

Types of Conduct Considered Fraud

Any type of action that uses deception to obtain funds from Medicaid could be considered fraud. Such conduct includes willfully making false statements, misrepresenting information, or concealing facts.

In recent Medicaid fraud cases, health care providers were accused of:

  • Billing the program for services that were never performed
  • Recommending patients for unnecessary tests and prescriptions
  • Paying bribes to medical professionals for patient referrals
  • Billing for prescriptions that were never provided to patients
  • Listing a regular office visit as something else
  • Having a patient return for office visits when none were needed

For Effective Legal Counsel in Denver, Contact David L. Owen, Jr., P.C.

Have you been charged with a federal crime? Reach out to Attorney David L. Owen, Jr. for the aggressive defense you need. He will work hard to protect your rights and seek a favorable outcome on your behalf.

To get started on your case, call (303) 622-3281 or fill out an online contact form.