The Need To Avoid Medicaid And Medicare Fraud

Many people are unaware that there are laws govern the Medicaid and Medicare programs

that when violated also violate the Federal and State False Claims Acts, which is a very strict class of regulations that constitute fraud.

Fraud in the United States is a federal offense that can carry with it very harsh punishments including imprisonment and a lifetime sentenced to live with a felony record. Given this fact, it is important to understand which Medicaid and Medicare laws constitute as regulations covered under the Federal and State False Claims Act.

Medicare and Medicaid law is diluted at best with the medical system becoming so complicated that it is easy to get confused between what is considered smart negotiation and what is actually bending or breaking laws in order to get the most back out of the system. Most people want the system to work for them, but this is not the sole aim of these programs as they were implemented to provide for people, not to supplement their lifestyle.

Some of the regulations that are felonies under the Federal State False Claims Acts are fraudulent acts that are committed by physicians and medical institutions while others are regulations that can be broken by normal citizens unaware that they are actually committing fraud.

Common acts that medical institutions may commit that fall under violations of Medicare and Medicaid programs and the Federal State False Claims Acts usually encompass billing fraud.

For example, billing for services that were never actually rendered, adding medical procedures to a bill that were not needed in order to receive a large reimbursement from Medicare, billing for tests that were not given, running a second test without justifiable cause or when a patient did not ask for it, or billing for expensive equipment when in fact a lesser type of equipment was used.

In these cases the individual that received or did not receive these tests will not be held liable since the medical institution is the one that doctored the bill.

However, if an individual submits a bill to any of the Medicaid or Medicare programs for services that were not performed, extra tests that were not medically advisable, and any of the equivalent billing matters mentioned above than they will be held liable.

In addition, prescription rebate fraud in which an individual receives a rebate for a medication due to a prescription program from the individual drug company and then still asks for reimbursement from the Medicaid program is also considered fraud and will result in criminal action.

This is considered lying to the government about the cost of the medication and constitutes as a very serious offense. Finally, the most common offense is forging signatures of a physician when Medicaid or Medicare specifically asks for such before offering reimbursement.

by: Gen Wright

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