What Is Medicaid Fraud?

What Is Medicaid Fraud?

If you operate a medical practice that accepts Medicaid, you probably know that Medicaid fraud is a big problem that the government does its best to identify and eliminate. This means that you could be in big trouble if your practice is accused of committing Medicaid fraud in any way. If you want the best chance of avoiding this type of accusation, it’s important to first know what Medicaid fraud is and how you can reduce your risk of being accused of it.

The Definition of Medicaid Fraud

In short, when you misuse or take advantage of the funds you get for accepting patients with Medicaid, you are committing Medicaid fraud. This is because you are taking money from the government, which essentially means you’re stealing from the taxpayers. The result is that you’re helping to increase the cost of a program that’s already considered expensive at more than $500 billion per year nationwide and over $35 billion in Texas alone.

Now you know why the government is so strict about using Medicaid funds properly. But what constitutes Medicaid fraud? There are a few ways that medical practices might defraud this program, whether purposely or accidentally.

One is billing fraud, in which the practice bills the Medicaid program for services that were never performed on the patient. On the flip side, a practice might provide unnecessary services after diagnosing a condition that the patient does not actually have and then ordering tests and treatments that he or she does not need. Or they might perform one service for a patient but bill for a more expensive alternative.

Some practices commit the type of fraud known as unbundling, in which case they charge separately for a group of services that are typically paid for together at a discounted rate. This way, they make more money as a practice. If any of these habits are something your medical practice has done, you risk being reported and investigated for Medicaid fraud.

How to Avoid Committing Medicaid Fraud

As you can see, there are several types of fraud when you accept Medicaid payments. If you want to avoid any accusations against your practice, it’s helpful to begin by making sure your entire staff knows the importance of only billing for services rendered to patients. Stress how crucial it is for them to complete coding and billing accurately, and to keep records of all patients’ diagnoses and treatments.

You should also steer clear of any conflicts of interest — including kickbacks — when it comes to providers to whom you refer patients, vendors who keep your office stocked with products and other medical providers your practice might work with. If you’re not sure if you have any conflicts of interest that would look bad to the government, consider whether you’d be okay with your arrangement making front page news. If not, you should avoid the situation to ensure that no one thinks you’re committing fraud.

Why You Need an Experienced Lawyer to Fight Medicaid Fraud Accusations

Even if you’ve done everything possible to run your practice correctly, you might face an accusation of Medicaid fraud. Whether or not it has any merit, you need to hire a Houston Medicare fraud lawyer with experience defending medical practices from this type of charge. This is because if you are found guilty, you could owe thousands of dollars in fines, be unable to accept Medicaid patients anymore or even get shut down.

In fact, some practices are so proactive that they hire a lawyer as soon as they start accepting patients who have Medicaid. This is often the best way to prevent accusations of fraud. Fortunately, if you’re looking for legal help for your medical practice in Texas, you have access to an experienced Houston federal criminal defense lawyer.

Contact The Kretzer Firm today to find out how we can help you.

Phone: 713-775-3050
Fax: 713-929-2019
Houston, TX 77002
440 Louisiana, Suite 1440