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What is Medicaid fraud?

Many people in West Virginia rely on Medicaid to supply them with medical insurance. If you are one of these people, this coverage is probably very important to you. However, it can be taken away if abused. It does not even have to be you who abuses it. Medicaid fraud put everyone at risk of losing benefits. There are several ways a doctor may commit this type of fraud.

According to the Centers for Medicare & Medicaid Services, Medicaid fraud often happens through deceptive billing practices. For example, a doctor may bill for unnecessary services or even bill for services he or she never provided. Some doctors may unbundle services to get higher rates or bill at a higher level for services performed.

Sometimes fraud is a little more complex. A doctor may allow someone else to use your Medicaid to get services. Knowingly doing this, is fraud. They may also collaborate with others to make false claims or accept kickbacks. Some doctors may falsify information to get people Medicaid coverage who do not actually qualify. Finally, there is also an issue with doctors who write or create false prescriptions to take those drugs and sell them.

In general, you are affected here. For example, if your doctor performs testing or does anything unneeded on you, it could harm you or at the very least inconvenience you. Improper billing affects the whole system by making it harder for people who need the benefits to get them. If you work with the doctor in any of these situation to defraud the system, you, too, could face legal problems and possibly lose your benefits. This information is for education and is not legal advice.

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