With millions of Americans benefitting from Medicaid each year, allegations of fraud are common. These accusations can target medical providers and beneficiaries alike. If you are facing charges for Medicaid fraud, an experienced fraud defense attorney can advise you on the next steps to take.
The criminal justice system is complex, but working with an attorney can help you level the playing field with the prosecution. A dedicated attorney at Berry Law can serve as your advocate during this challenging time.
Types of Allegations Against Medical Providers in Omaha
Doctors, administrators, and hospital employees can face Medicaid fraud charges for attempting to wrongfully pursue reimbursement. Provider fraud can come in many different forms. Often, it is as simple as a doctor billing for medically unnecessary services. This results in monetary reimbursement through Medicaid directly to the provider.
In other situations, providers might engage in “upcoding,” which is billing a simple procedure as a more complicated procedure that is reimbursed at a higher rate. Additionally, a doctor could even seek reimbursement for medical services that he or she never provided.
Some healthcare providers also take part in a criminal act known as unbundling. Medicaid generally provides a global code for a series of procedures that doctors commonly prescribe together.
Bundling them results in a discounted reimbursement compared to billing each procedure individually. A provider could unbundle these procedures to receive more money or double-dip by billing for both individual and global codes.
These types of criminal allegations could end a medical provider’s career. A hard-working defense attorney can assess the facts of the case to build a valid defense to your Medicaid fraud charges.
Allegations Against Patients and Beneficiaries
Some fraud claims do not involve the providers at all. Instead of attempting to obtain financial reimbursement from Medicaid, these individuals often seek medical care they would otherwise not be entitled to have.
Sharing Insurance Cards
One form of Medicaid fraud involves card sharing. This occurs when multiple people use the same insurance card and identification to obtain care. This form of fraud is a type of identity theft. In other cases, an individual could use multiple fraudulent cards to receive more treatment than he or she would individually.
Obtaining Prescription Medication
Often, the goal of Medicaid fraud is obtaining prescription medication unlawfully. Someone might commit this type of fraud to feed an addiction or sell the drugs. The prosecution might accuse the defendant of seeking treatment for non-existent medical issues. Alternatively, a patient or beneficiary might alter or forge a prescription for medication.
Collusion and Kickbacks
In some cases, beneficiaries and providers collude in their effort to defraud Medicaid. For example, a patient might ask for unnecessary treatment with the understanding that the doctor will approve it and seek reimbursement. In some cases, the patient is bribing the medical provider, which is known as a kickback. Prosecutors treat allegations of collusion harshly, so it is crucial to work with a Medicaid fraud attorney in Omaha on your case.
Speak with an Omaha Medicaid Fraud Attorney Right Away
The fallout from a Medicaid fraud allegation could be significant. In addition to criminal charges, you could face damage to your reputation, costly civil claims, or the loss of your professional license.