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MEDICAID FRAUD WHISTLEBLOWERS

What is Medicaid?

The Medicaid Program is a joint Federal and State program administered by the State that provides healthcare coverage to low income families. Approximately 19% of all Americans are covered by some form of Medicaid, meaning it is ripe for fraud.

What is Medicaid Fraud?

Medicaid Fraud occurs when healthcare providers knowingly submit claims to Medicaid that are inflated or not eligible for reimbursement.

What are some common Medicaid Fraud schemes?

Like Medicare Fraud, some of the most commons forms of Medicaid Fraud include:

  • Double billing;
  • Up-coding;
  • Billing for services that were not provided or not medically necessary;
  • Kickbacks schemes;
  • Physician Self-Referral Law, also known as Stark Law, violations;
  • Pharmaceutical marketing violations, including off-label marketing;
  • Inflating patients’ risk scores for managed care plans;
  • Improperly inflating drug pricing measures such as Average Sales Price;
  • Hospice fraud;
  • Improper inpatient admissions;
  • Unnecessary laboratory testing and physician kickbacks; and
  • Fake clinical trial and research schemes.

How is Medicaid Fraud Different than Medicare Fraud?

Unlike Medicare, Medicaid is administered by the State, meaning False Claims Act cases for Medicaid Fraud are brought under that State’s False Claims Act. Many types of Healthcare Fraud cases involve both Medicare and Medicaid, meaning many cases are simultaneously brought under the Federal False Claims Act and each State’s False Claims Act.

What can I do to stop Medicaid Fraud?

If you have knowledge and proof that a company or individual is submitting false claims in relation to Medicaid Fraud, then give us a call today for a free consultation and case review with an experienced whistleblower attorney.

This information is for educational purposes. It is not offered as and does not constitute legal advice or legal opinions. You should not act or rely upon this information without seeking the advice of an attorney.

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