Blog
Medicaid Fraud Settlements
Medicaid fraud is an occurrence of which many providers and recipients are accused. Medicaid fraud includes a wide variety of actions and omissions of actions that result in a person receiving benefits to which he or she is not entitled. Medicaid fraud can include a medical facility receiving payment for services to which it is not entitled, as well. The government is starting to crack down on its investigative efforts and its prosecutions. Yearly Medicaid fraud incidents add up to billions of dollars. Persons who are found guilty of such fraud can face a wide variety of harsh penalties.
Examples of Medicaid Fraud
As previously stated, a wide variety of situations may be considered as Medicaid fraud. First a recipient has to meet income guidelines to qualify for Medicaid. The person must have income that is below the poverty level. An applicant can manipulate his or her income as to qualify for Medicaid. Such manipulation is Medicaid fraud. Another example of Medicaid fraud is when a person does not report insurance that he or she already has. Some Medicaid applicants may have employer-issued coverage or some other coverage that they fail to report. Gaining approval for Medicaid benefits without reporting existing benefits is Medicaid fraud.
A person who has Medicaid benefits cannot allow another person to use his or her benefits. The state approves Medicaid benefits only for the person who applies for it. Therefore, Medicaid fraud occurs when someone else uses the card.
Providers can be just as guilty of Medicaid fraud as recipients are. One fraudulent act that a provider may conduct is billing the Medicaid office for services that it has not rendered to a patient. The provider may bill the Medicaid office for services that the patient did not need, as well. An example is a provider that bills Medicaid for administration of a nebulizer treatment that the patient did not need. The government provides an easy way for people to report instances of Medicaid fraud. Therefore, an accused party may be under investigation shortly after someone places an anonymous tip with a government organization. The penalties for Medicaid fraud are extensive, and anyone who receives a charge would fare well by hiring an attorney who can come up with a viable defense to the charge.
Punishment for Medicaid Fraud
The penalty for Medicaid fraud can vary depending on the offender’s circumstances. The investigation will include a series of questions as the issuing organization tries to find out whether the accused person was intentionally fraudulent. Next, the investigator will review medical documents, bills, income information and any other information that is relevant to the case. The punishment for fraud will most definitely include temporary or permanent suspension of benefits for an individual who commits the crime.
Medicaid fraud is severe because it is a federal crime. A person who is accused of fraud can be subject to criminal and civil charges. A criminal conviction can land a person in prison for as long as five years with a fine of up to $200,000. A corporation that is found guilty of Medicaid fraud may be subject to a $500,000 fine. The civil penalty for such a crime may include an additional fine of up to $10,000. The consequences of Medicaid fraud can be long-lasting for anyone who receives a conviction. The guilty party will have difficulty receiving assistance from the government in the future. A person will have difficulty getting hired for a job in the future, as well. A corporation may lose business and investors.
Medicaid Fraud Settlement
Medicaid fraud settlement is a situation in which a corporation or a person settles out of court on a Medicaid fraud charge. Medicaid fraud settlements usually occur when someone accuses a corporation of Medicaid fraud. The corporation may be allowed to pay a set fine to keep the proceedings from going to levels that would put the corporation out of business. Additionally, the offending corporation may be instructed to allow a third party to monitor its operations during a probationary period. A deferred prosecution agreement is one that allows an accused party to enter a settlement to defer harsh penalties.
Help from a Medicaid Fraud Attorney
Any party that is facing Medicaid fraud charges is up against some stiff consequences. The offender’s best bet is to contact an experienced Medicaid fraud attorney such as Joseph Potashnik & Associates. The firm can provide an accused party with a free consultation, and interested parties can schedule their consultations any time of the day or night by calling 212-577-6677. The initial consultation is free, which makes the entire process risk-free. The attorney will help the accused party to find the best and most effective way out of the turmoil associated with Medicaid fraud charges.