LAW OFFICE OF MANSFIELDCOLLINS
 
 

GOING ALL THE WAY WITH YOUR CASE    

SINCE 1982  

 

MEDI-CAL MEDICARE/FRAUD

Medicaid/Medicare Recipient Fraud

          A Medicaid recipient may face a medicaid fraud investigation as well as criminal charges

due to any of the following: Stating false facts on the application to receive medicaid despite being

ineligible; Loaning Medicaid to another person; Forging or altering a prescription or fiscal order; Using

multiple Medicaid cards; Intentionally receiving duplicative, excessive, contraindicated or conflicting

health care services or supplies; and Re-selling items provided by the Medicaid program.

Medicaid/Medicare Provider (Medical Office) Fraud

          A provider may face a fraud investigation or criminal charges for any of the following:

Billing for services that were not provided, e.g., a chest x-ray that was not taken;

Duplicate billing which occurs when a provider bills Medicaid and also bills private

insurance and/or the recipient; Requiring the recipient to return to the office for more

visits when another appointment is not necessary; Taking unnecessary x-rays, blood

work, etc.; Upcoding, e.g., providing a simple office visit and billing for a comprehensive

visit; Having an unlicensed person perform services that only a licensed professional

should render, and bills as if the professional provided the service; Billing for more time

than actually provided, i.e., counseling, anesthesia, etc.; Billing for an office visit when

there was none, or adding additional family members' names to bills; and, Accepting

payment from another provider, including sharing in the reimbursement paid by the

Medicaid program, as a result of referring a patient to the other provider.