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Medicaid was created with the idea of providing health insurance alternatives to more than 72 million Americans who qualify. They can be from low-income families, pregnant women, children, seniors with disabilities, anyone without vision, and anyone who qualifies for federal income assistance with the federal government. It’s healthcare provided by both the state and the government for those who can’t afford to pay for their own insurance. While it’s exceptionally helpful to those who benefit from Medicaid, it can be the downfall of a doctor or medical facility. Medicaid fraud occurs to the tune of billions of dollars each year, and it’s expensive.
– Prison time
– Hefty fines
– Loss of a medical license
– Loss of a professional business license
– License suspension
These are just a small sampling of the kind of trouble Medicaid can cause doctors who are accused of Medicaid fraud by the Medicaid insurance program’s investigative team. Whether you know it or not, your future is at risk for being investigated for Medicaid fraud. Many doctors around the country willfully and knowingly engage in Medicaid fraud as a way of increasing the bottom line. The profits are substantial, and not everyone is honest.
Many doctors, however, are honest. They go to work each day to care for patients and their health needs, and their reputation is ruined because of a simple mistake or someone else’s negligence. If your medical license is being investigated for Medicaid fraud, don’t wait to call a Medicaid audit attorney to help. Our job is to protect you, make you aware of your rights, and insure fraud auditors are working with the legal confines of the law throughout the course of their investigation.
Why Am I Being Investigated?
Most cases of Medicaid fraud are thrown out by the end of an investigation. There are always offices engaging in the fraud willingly, but most fraud is a simple mistake, an error, or even an ongoing error someone is not aware of. If you’re being audited because your office is flagged for Medicaid fraud, it’s because of one of the following reasons.
1. Duplicate billing is received by Medicaid. Many instances of this occur within Medicaid departments. Most doctors utilize a billing company to handle claims, and they’re not always good at making sure they’re handled correctly. If an office assistant sends in a claim in addition to the billing company sending one it, it raises red flags within the Medicaid fraud department. It’s usually a simple error, but it’s one that can cost an office.
2. Overcharging patients for their services is another big red flag for Medicaid fraud auditors. When this happens, it’s either done on purpose to solicit a bigger payment from the insurance company or as a mistake. When it’s a mistake, it’s usually at the hands of an administrative assistant who either read the patient’s file incorrectly, entered the wrong code, or mixed up patient files with their charts. It happens all the time.
3. Charging for procedures not provided to patients is a red flag. This one isn’t always noticed unless the patient is able to see their medical billing records. Otherwise, Medicaid insurance offices have no idea whether a patient received specific procedures or not. However, it might raise red flags at the Medicaid billing offices if a doctor’s office has numerous patents with ample procedures being performed on a regular basis. It might lead Medicaid auditors to believe someone is falsifying patient records for profit.
Investigations typically result in the finding of an error in the billing department, the administrative staff, or in the entering of a code onto someone’s file. It’s usually easy to correct, and no one faces any legal trouble following the conclusion of the audit. Since your legal profession, license, and practice is at risk during an audit, you want legal expertise on your side. It’s not convenient to take focus off your patients to handle legal issues of this nature, which is just one of the benefits of using a Medicaid audit attorney during the course of an investigation. It can change the course of the audit and benefit the medical practice significantly.