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Do you know the types of Medicaid fraud?

On Behalf of | Jan 6, 2020 | blog

Some crimes are not violent and may not involve a clear victim. These crimes often fall under the umbrella of white collar crime. They usually have some type of financial motivation. One such case is Medicaid fraud. This also is a federal crime, and it can happen in many ways in California. Generally, it involves breaking the rules regarding billing or taking advantage of the system in some way. 

The Centers for Medicare and Medicaid Services explains Medicaid fraud may happen in a variety of ways as instigated by a doctor, billing personnel or even a patient. There are a few different types of fraud involving Medicaid that occur most often. 

Billing fraud 

Many of the incidents happen when a doctor bills incorrectly on purpose. This can include billing for services he or she did not provide or for services that a patient does not need. It may also include wrongly coding items to get more money from Medicaid. 

Something else that may fall under this type of fraud is collusion. This is where a patient may work with a doctor to falsify billing documents. Genuine mistakes do not fall into this category, but someone should eventually discover and properly resolve such a mistake. 

Identity fraud 

Another common area is the misuse of Medicaid cards. This could be one patient using another patient’s card to get services. It can also include a patient getting prescriptions for medications he or she does not need to then sell those drugs on the street. Some people may also try to pass off fake Medicaid cards to get services. 

Any situation where someone gets money for services under Medicaid and those services were not legitimate in some way is fraud. This is not a victimless crime. It affects everyone because it takes money from the system that taxpayers fund and low-income people rely on. This makes it a serious issue that requires attention.