Medicaid fraud and abuse are not only against the law, but it costs billions of dollars every year in diverted funds that could have been used for legitimate health care services. Furthermore, fraud and abuse result in unnecessary increases in the cost of Medicaid. Even worse, fraud and abuse increase the risk of harm to patients who are unsuspectingly exposed to medical procedures that are not required. However, if you engage in Louisville Medicaid planning, with Gersh Law Offices, P.S.C., you can avoid inadvertently committing these violations.
What do Medicaid fraud and abuse involve?
Medicaid fraud occurs anytime anyone knowingly misrepresents the truth in order to obtain Medicaid benefits to which they otherwise would not have been entitled. This type of fraud is committed by patients and health care providers alike. Medicaid abuse, on the other hand, refers to any practice that is inconsistent with acceptable economic, business or medical practices and that unnecessarily increases the costs of this benefits program. Both fraud and abuse violate Medicaid law. But with the help of Louisville Medicaid planning with Gersh Law Offices, P.S.C., you can avoid violating the law.
Illustrations of patient fraud that violate Medicaid law
Examples of patient fraud include filing a claim for Medicaid services or medical products that have not been provided to the recipient, altering or forging receipts for the purpose of receiving reimbursement from Medicaid or the procurement of medications or medical equipment that was not actually required by the patient, and then selling that equipment or medication on the black market. Providing false information when submitting an application for Medicaid services is a violation of Medicaid law, as is so-called “shopping” for doctors so you can obtain numerous prescriptions for the same medication.
How patients can avoid fraud
In order to avoid unknowingly committing Medicaid fraud, there are a few things you need to avoid. First, do not contact your doctor to request a medical service that you do not actually require. Second, do not let someone else convince you to see a doctor for medical care or services you don’t need. Finally, never sell any medication or supplies you received through Medicaid, even if you later determine that you do not need them.
Common examples of Medicaid fraud by health care providers
Medicaid fraud is not only committed by patients. It can also be committed by health care service providers. Following are some common examples of Medicaid fraud often committed by health care providers.
- Billing Medicaid for services not actually performed
- Submitting duplicate billing for the exact same service
- Submitting a false diagnosis covered under Medicaid
- Billing for more expensive procedures or services than were actually performed
- Receiving kickbacks for patient referrals
- Billing for services covered by Medicaid when a non-covered service was actually performed
- Ordering unnecessary or excessive labs or other diagnostic tests
- Prescribing medication that is not medically necessary
There are many different ways to know if provider fraud is occurring with regard to your own medical care. First of all, every time you receive health care services covered by Medicaid, you should maintain a record of the dates you received those services and retain the receipts and statements you receive from providers. If you do that, you can compare the dates and services recorded in your records with the statements you later receive from Medicaid.
How to avoid the appearance of fraudulent transfers
A common misconception with regard to Medicaid is that you will need to give away all of your property before you can qualify for Medicaid benefits. As a result, you may mistakenly believe that you can transfer your property to family members in order to reduce your estate. The problem is, you cannot simply give away your property when you decide to apply for Medicaid.
In fact, there was a law passed in 2005 which created a period of ineligibility for anyone who transferred their property to someone else at any time within five years of submitting their application for Medicaid benefits. Because the period of ineligibility begins when you actually apply for Medicaid, timing is very important and creating a Medicaid plan early is crucial.
Medicaid trusts are a wise strategy for Louisville Medicaid planning
A Medicaid Trust is a specific type of trust used to protect a Medicaid applicant’s property so that you can maintain your eligibility for Medicaid benefits. A Medicaid Trust is an irrevocable trust that allows you to be the income beneficiary while identifying residual beneficiaries who will receive the trust property after your death.
If you have questions regarding Medicaid fraud or any other Medicaid planning matters, contact Gersh Law Offices, P.S.C. for a consultation either online or by calling us at (502) 423-7023.