Medicaid Fraud

Medicaid is a very good program that is to help those that need medical and dental coverage. In most instances, without the Medicaid they simply wouldn’t be able to afford it. Therefore they wouldn’t get the care they needed, especially when it comes to preventative care. One issue with Medicaid though is that it isn’t always used as it should be. There are problems with fraud both from people approved for the program and by providers.

Medicaid fraud happens in many ways from the individual side of things. A person many not report all of the information on their application correctly in order to be eligible. They may end up omitting income or various household members that have a sufficient income to contribute to the household. It also occurs when someone allows another person to use their Medicaid card for services.

There are auditors in place to review charges by medical providers. They look for patterns of behavior when it comes to billing of Medicaid patients. They want to make sure they aren’t billing for things that haven’t occurred. They also want to make sure Medicaid patients aren’t being subjected to tests that they don’t need in order for them to make money.

There are also fraud hotlines where people can call in to report other people who may be getting Medicaid benefits fraudulently. A person can make such reports anonymously so that they don’t have to tell anyone who they are. Generally it is friends or family members that don’t feel it is right that someone is illegally getting such benefits that turn them in. Most departments of human service agencies have a fraud unit that can investigate such matters.

It is believed the Federal government is bilked out of millions of dollars annually due to the various forms of Medicaid fraud. As a result they have implemented harsh penalties for those caught to be involved in such forms of fraud. Individuals have had to repay the funds, pay a fine, and even serve jail time as part of the requirements under our justice system. The repercussions for any form of Medicaid fraud aren’t going to be lenient. You can be sure the Federal government is working hard to make examples out of those they do catch.