Medicaid Fraud is an offence that affects people throughout the country. It is an illegal activity and might be committed by a single entity or by an organization. The Medicaid system was created in 1965 to offer healthcare poor income people across the nation. But lots of Medicaid fraud is happening ranging from an individual fraud to large-scale Medicaid fraud, thus, deceiving both government and the common man. The one who is committing the crime could be a doctor, dentist, or any other health care professional. http://www.medicaidfraudhotline.com/. If anyone is suspecting Medicaid fraud or abuse, they can report it to the State Medicaid Agency in person or through an attorney.
Signs of Medicaid Fraud
Medicaid fraud is a complicated and sensitive issue. It can happen at any level – Provider Fraud, Member Fraud and Employer Fraud. In case of a provider fraud, few of the signs that could be seen are
Billing not performed for the services
Billing for a service not performed or billing for a costlier service than it was actually done
Recommending tests and other procedures that are not necessary
In the case of Member Fraud, few of the signs could be
Using an insurance card that they don’t own
Providing false information while enrolling, for more health coverage
In the case of Employer Fraud, few of the signs could be
False information on the employee hire date
False information on the employee termination date
Finding out a Medicaid fraud is very difficult. This is because the person who commits this fraud tries to hide his action. So, in case of suspicion, it is always better to look out for evidence.
Victims of Medicaid Fraud
Any who is dependent on the Medicaid scheme could be affected by Medicaid fraud. Of all the recipients, a few set of people are often targeted and are more vulnerable than others. Some of the people who are affected are
Patients above the age of 60
Patients who are mentally ill
Patients who are home-bound
Nursing home patients
Reporting a Medicaid Fraud
It is important to report Medicaid Fraud to the government about the people who are engaged in committing the crime. There is no need to wait for someone else to report the issue. It is important to act quickly because the actions have to be filed within a certain amount of time. It should either be filed six years from the date of violation of the act or 3 years after the government knows about the violation. By any means, it should not be reported 10 years after the date in which the fraud was committed. So, before the evidence and witnesses fade, the fraud should be reported.
Being a Whistle blower
Any individual who has first-hand information about a Medicaid fraud being committed, can report it to the government. Any person who is honest and hardworking and has right values that does not match with that of his employer can report about his employer’s fraudulent activities.
The government rewards such individuals who help to uncover the Medicaid fraud by paying large amounts. The whistle blower rewards could amount to even thousands of dollars depending on the crime. It is better to report the crime as the whistle blower gets legal protection to certain amount.
Under the false claims act, the whistle blower can consult an experienced whistle blower attorney to discuss about the case. The consultation with the attorney is usually free and confidential. After looking into the case and determining its worth based on the evidence, the attorney would work on it and file a complaint under seal. The evidence provided by you will then be submitted in the court to a government prosecutor. Based on the evidence, the case would be investigated and carried forward.
If the case is pursued and wins, the whistle blower is entitled to get around 15%-25% of the amount that is recovered by the government. Even if the government doesn’t take up the complaint, the whistle blower and his lawyer can take up the case on their own and have the possibility of winning 25%-30% of the amount recovered. The attorney will be paid a percentage of the amount only if the whistle blower wins.
Medicaid Fraud is more than just money. It means denying proper aid for the real needy. Bringing those offences in front of the law is important for the welfare of every citizen.