The defrauding of Medicaid is a serious enough problem that it costs billions of dollars from the states each year. You can be sure law enforcement will take accusations of Medicaid fraud seriously. It is not just patients who engage in this kind of fraud, however.
According to the National Conference of State Legislatures, insurance companies and physicians may also engage in deceptive practices to abuse the Medicaid program for their own benefit. Here is an overview of how some patients, health care providers and insurers attempt to defraud Medicaid.
Fraudulent activities by patients
Patients who want Medicaid services without a genuine need for them may go about it in several ways. They may file a claim to cover non-existent services or products. They may change an existing receipt or forge a new one to gain coverage. Other fraudulent methods include doctor shopping, using another person’s insurance or misrepresenting one’s identity.
Fraudulent activities by providers
Health care providers tend to defraud Medicaid by billing for services and medicines that a patient does not need in order to pocket the coverage. Sometimes a provider submits multiple bills for the same service. A provider may also compose a phony diagnosis to get payment for a treatment that will never happen. Providers may also write unneeded prescriptions to get Medicaid money and/or acquire prescription medicine for illegal uses.
Fraudulent activities by insurers
An insurance company can defraud Medicaid in several ways. It may overstate insurer costs for a Medicaid claim. An insurer can give people who have enrolled in the Medicaid program false information about how health plan benefits work. Sometimes a fraudulent insurer will misrepresent the value the insurer owes to a health care provider to get out of paying a full amount.