Hearing the term Medicaid fraud may conjure up images of lawyers and government officials, but the true cost is actually much closer to home for many people. Fraud and abuse in Medicaid cost taxpayers billions of dollars every year. Funds intended to help the sick end up being wasted.
But worse than the wasted time is the risk to patients caught up in unnecessary procedures that just line the pockets of unscrupulous health care companies. Imagine if you found out that your child had an unnecessary surgery just so that agency could make a few hundred dollars.
What is Medicaid Fraud?
Medicaid fraud involves knowingly misrepresenting the truth to obtain the benefits. It can be as simple as ordering unnecessary tests to as complicated as a multi-million-dollar scheme to deceive taxpayers. People depend on this program for their lives, it’s important to protect the program’s integrity by fighting Medicaid fraud.
How to Spot Fraud in Action
There are a few different ways that Medicaid fraud can pop up. Here are a few scenarios to keep in mind.
Claims Filed, No Services
One popular way to defraud the system is for a doctor to file claims on services the patient never received. This counts on people being confused and intimidated by high medical bills. Look at your bill, examine the tests, ask questions when something seems off.
Unauthorized Use of Medicaid Number
There are some people out there that actually “rent” their Medicaid number to others. Even doctors can be tempted to “rent” another doctor’s provider number. In this case, both providers and recipients can be in on the criminal action. It may fall upon a third party to report the Medicaid fraud.
For some people, things like wheelchairs and walkers are a necessity to everyday life. But more than a few people take advantage of the system by trying to scam unnecessary equipment. If a doctor offers you a free wheelchair or a company insists you use only their doctors—something might be up.
This takes advantage of the system that hospitals use to determined billing and level of medical care. Sometimes outlandish fees can be charged for bandages or aspirin, all to make a buck. Most of the time a diligent employee can blow the whistle on this type of scam.
Some less-than-honest doctors may try and send two bills to the government, hoping they won’t notice the discrepancy. Some doctors’ offices and practitioners will bill private insurance companies as well as government programs, or two providers will request the same payment. It falls on bureaucrats to notice and do the right thing by reporting the fraud.
Being a Whistleblower
If you notice the signs of Medicaid fraud there are actions to take. In many cases it falls to the people within the company themselves to blow the whistle. In addition to doing the right thing, there are also incentives for helping the greater good.
Make the Call
Once you’ve noticed an issue, don’t keep it to yourself. Contact an attorney, like Jeffrey Newman, that specializes in whistleblower cases. They will walk you through the process and prepare you for what comes next.
Don’t Discuss the Case
Most whistleblower cases will involve some sort of reward, so it’s important to keep the details between you and your attorney. It’s important to note that some state laws require employees to bring the fraudulent activity to the attention of a supervisor. But if you have reason to believe your supervisor is in on it discuss the options with your counsel.
Follow the Rules
A lot depends on how things were collected in order to be proved in court. Whistleblower cases must be based on facts. In some states, taking documents from the workplace is illegal. Speak with an attorney about any evidence you have already gathered. Ask if you have any questions regarding what’s legal.
Listen to Your Counsel
The job of your attorney is to protect your rights. Consider it a partnership in fighting Medicaid fraud. Follow your counsel’s expert advice as closely as possible.
Fighting Medicaid fraud takes diligence and dedication. It can be a long process but the common good is at stake. Stay alert for something that doesn’t feel right and take action that will protect yourself and the millions of people who depend on the program
To blow the whistle on suspected Medicaid fraud or learn more about how to proceed, contact Jeffrey Newman Law today.