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Los Angeles medical offices are required to accept patients with Medicaid. Medicaid is a dually-funded program offered by the state to anyone who has a disability, lives in a low-income household, or is legally blind. There are other laws that allows people with other situations to use Medicaid in lieu of traditional insurance, too. Unfortunately, thousands of doctor’s offices face legal issues when they accept Medicaid. If the Medicaid program suspects fraud of any type is going on in a doctor’s office, they’ll investigate the office to prove the office is guilty or innocent of the crime.
Anytime your medical facility is faced with a Medicaid audit, it’s imperative to contact a Medicaid audit attorney with experience. This is an attorney who can help you get through the process without spending your time away from your patients and their health needs. They know the law, they can help you assist in the audit without providing too much information, and they can ensure the audit is within the confines of the law at all times.
Medicaid Fraud and Audits
Audits are not always a sign your office is doing anything illegal, which is the most important thing to keep in mind. It’s not a direct indication you are breaking the law as a doctor or physician. Many of the flagged files that make it into the audit file are simple mistakes, and many are completely legal. It’s small things that often lead to a red flag.
– Duplicate Bills: If a Medicaid office receives duplicate bills for the same patient for the same procedures, it raises a red flag. Is the medical office looking to obtain two payments from Medicaid? Or was there a clerical error made on behalf of the billing company or administrative staff at the office? Perhaps one employee thought he was to send off certain bills to Medicaid and another thought the same thing, resulting the submission of duplicate bills by mistake.
– Overcharging for Procedures: Medical facilities charge certain amounts for different procedures. If a bill makes it to the Medicaid offices that’s incorrect, it could be an attempt to overcharge for a bigger profit. It could be a simple clerical mistake in which an additional 0 was added into the amount when someone didn’t double check their work after entering the numbers.
– Falsifying Information: When Medicaid receives bills for clients they deem false, they suspect fraud and will audit an office. This could happen when a patient provides false information unbeknownst to the office, or when an administrative assistant makes a small mistake entering a patient’s personal information in the system.
There are dozens of reasons a Medicaid office might flag a medical facility for fraud, and each one will result in an audit. Billions of dollars in overpayments are made by Medicaid offices each year throughout the country, and the government is working to put a stop to this. Many of those overpayments are mistakes that are easily corrected by an office, but some result in criminal charges.
If you are accused of Medicaid fraud following an audit, your attorney will work to reduce your sentence. Disciplinary actions are severe for defrauding the federal government. Anyone found guilty of Medicaid fraud could face up to 5 years in prison for each count of fraud for which they’re found guilty. They also face up to $10,000 in fines for each count of guilt. Furthermore, the doctor might lose his or her state license, and all doctors are required to pay restitution equal to or exceeding the amount defrauded from the government.
Medicaid fraud is a serious crime, which is why auditors want to find it become it becomes a bigger problem. For many offices, the results of an audit show simple mistakes that might be a trend with the administrative staff they aren’t even familiar with. Small fines might be charged, but attorneys can work to lower those fines and provide legal counsel to ensure these mistakes are not made in the future. Don’t respond to an audit until you’ve discussed your case with a Medicaid audit attorney with experience handling these cases in California.