San Diego Criminal Lawyers Blog
Every year, millions of dollars are lost to Medicaid fraud. The array of crimes connected to Medicaid Fraud is grounded in the misrepresentation of facts or the provision of false information to collect Medicaid payments. It can occur when organizations or individuals bill Medicaid for services they did not provide, change billing codes to get reimbursed for more expensive services, or receive kickbacks. The crimes are costly, as are the penalties for a conviction.
What Constitutes Medicaid Fraud?
Medicaid fraud occurs in various ways. Knowingly defrauding any health care benefit program violates federal statute. In fact, even intentionally ignoring the truth in these matters can lead to criminal charges. The following crimes occur most commonly:
Offering deceptive information in order to participate in Medicaid;
- Neglecting to sufficiently conduct medical screening for patients who are in labor or experiencing another emergency in a hospital emergency room;
- Furnishing fabricated or deceitful information in an attempt to influence discharge decisions for a hospital patient;
- Submitting claims to Medicaid for procedures, materials, or services that a patient either did not need or did not receive;
- Performing one service, but billing for a more expensive one;
- Billing two entities, such as Medicaid and another insurance company or the patient, for the same service
- Receiving money or paying money in exchange for referrals;
- Neglecting to chronicle and return any mistaken overpayments from Medicaid within 60 days of discovering the problem;
- Billing separately and at higher rates for services that should be combined into one lower price;
- Misappropriating health care providers’ medical numbers or other identifiers;
- Buying or selling Medicaid numbers;
- Obtaining medical services or funds using someone else’s Medicaid name and number.
Penalties for Medicaid Fraud
Anyone facing charges of Medicaid fraud is looking at the possibility of extensive penalties that include:
- Losing the ability to work with any federal government health care programs, including both Medicaid and Medicare, as a result of being put on the Office of Inspector General’s exclusion list. That could be career-ending for someone in the medical world;
- The possibility of having one’s professional license revoked by the state medical board, which is another serious problem for nurses, physicians, pharmacists, and others;
- Having assets linked to the crime, from vehicles to other property to bank accounts, seized by the government;
- Civil fines of upwards of $27,000 per infraction, along with triple the loss to the Medicaid program;
- Criminal fines of as much as $250,000;
- Imprisonment for up to ten years per count.
Fighting for You
The aggressive and experienced criminal defense attorneys at Boertje & Associates appreciate the seriousness of these charges and understand just how devastating a conviction can be. We will fight to safeguard your rights and to achieve the best possible outcomes. To discuss, schedule a confidential consultation in our San Diego office today.