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Medicaid fraud: basic information

Individuals who have limited resources or low-wage earning families can rely on Medicaid to obtain health care services. Here in Louisiana, both state and federal officials monitor the Medicaid program to ensure that the system provides legitimate health care to deserving individuals while preventing abusive practices that tax the system. Readers need to understand that patients, providers and insurers can be charged with Medicaid fraud by committing some of the offenses that are outlined below.

Providers can be arrested for fraud for billing for services that never occurred, multiple bills for one service, falsification of diagnosis, overbilling, accepting kickbacks of referrals, administering inappropriate tests and prescribing unnecessary medicines to patients. Patients can also be charged-- they can be charged with fraud for filing a claim for products or services that they never received, forging receipts, obtaining unnecessary medications and selling them later on the black market, providing falsified information to obtain medical services and using someone else's insurance coverage to obtain healthcare services. Insurers can also be charged with fraud by denying valid claims, overstating insurer's costs in paying claims and failing to inform the enrollees about the health plan coverage.

Medicaid fraud may stem from errors in documentation. It is important for providers, for example, to check the claim before filing them in order to avoid fraud-related cases. Patients, on the other hand, should always check if their claims contain all the services they received before filing them in order to avoid fraud charges. These simple steps can help individuals avoid fraud related cases that often lead to life-altering consequences. In the event that they were charged with Medicaid fraud, it is important to seek legal help from knowledgeable legal professionals.

Locally, people who have been charged with federal health care fraud may choose to seek help from criminal defense attorneys who understand the intricacies of the legal system. These professionals can help construct a solid defense for trial.

Source: Ncsl.org, "Medicaid fraud and abuse," Accessed on Jan. 5, 2015

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