Most people who use Medicaid do so because they have limited resources to pay for health coverage. Many of its participants and providers abide by policy rules. Yet, you may find yourself accused of Medicaid fraud if you tried to receive benefits than were not due you or your company. By understanding the types of and consequences for Medicaid fraud, you can prepare for the potential impact of your charges.

What counts as Medicaid fraud?

Medicaid fraud refers to illegal actions that providers or patients take to receive unnecessary or excessive payouts from the government program. These behaviors often occur on the billing end of medical operations but are not limited to it. If you are a provider, you may face Medicaid fraud accusations if you:

  • Arranged or received kickbacks in exchange for patient referrals
  • Charged patients for unnecessary services
  • Charged patients for more expensive services than provided
  • Charged patients for services not provided
  • Wrote unnecessary prescriptions for patients

Yet, patients can commit Medicaid fraud, too. If you are patient, you may face Medicaid fraud accusations if you:

  • Colluded with your doctor so they can receive payouts on false claims
  • Committed identity theft to receive services you lack eligibility for
  • Filed to reimburse services you never received
  • Lied about your circumstances to receive Medicaid eligibility
  • Received payment from your doctor for referring other patients

What are the consequences for Medicaid fraud?

In Louisiana, patients and providers accused of committing Medicaid fraud face the same penalties. No matter which you are, you could face a prison sentence of up to five years for your actions. Furthermore, you may face fines of up to $20,000, as well as a $2,000 payment for each false claim you filed. And you will face exclusion from Medicaid if you receive a conviction for defrauding the program.

Whether you are a patient or a provider, Medicaid participation is a privilege you could lose if you abuse its benefits. If you’re accused of defrauding the program, you will need to protect yourself by consulting a criminal defense attorney.

 

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