Medicaid Fraud And Its Types

Medicaid Fraud is a fraud committed alleged misrepresentation of the truth to enjoy unauthorized and unlawful benefits. This includes any and all types of illegal and unacceptable acts that do not comply with the prevailing laws and regulations related to medical and business practices that would result in the preventable increase in costs.

Medicaid Fraud is one type of fraud that has serious irreversible affects since it deals with the lives and welfare of the human community. Apart from monetary resources being wasted the other major issue related to the Medicaid fraud is the plight of the patients who are subjected to unwanted and irrelevant medications and procedures.

The most common types of frauds that fall under the Medicaid fraud includes:

  • Medical Identity Theft:

Businessman hands in handcuffs and holding ten dollar notes

This medical identity theft is the stealing ones medicals data to obtain ineligible benefits by impersonating the actual beneficiary. The patients’ identity might be used to acquire healthcare goods, services or funds illegally. This is not done with the patients’ data alone and the worst part is that even physicians identity is stolen and used to prescribe unnecessary costly medicines and refer the patients to unwanted additional services that might cost the patient more than the actual amount.

So it is the responsibility of the patient and the physician to safeguard their identity and restrict the unauthorized and illegal use of them by miscreants.

  • Billing for unnecessary services & Items:

A patient has to be treated in the right way depending upon his illness and ailment. The level of treatment provided to him should fall under the prescribed format and procedures as set out by the states laws and governing legislations such as the Social Security Act. Alleged billing of unnecessary services or medical/healthcare products will attract severe penal action.

  • Billing for services not rendered:

This case is even more worse and the patient is sometimes billed for a service that he / she has not been rendered. To make this fraudulent activity look real fake documentations are also prepared and submitted. If you are interested in medicaid fraud click on this link This happens with the help of a physician who allegedly signs a bill for a service that has not taken place. It is the authentic duty of the provider to bill only for services rendered and healthcare officials should exercise vigil and honesty while exercising their duty.

  • Upcoding:

medicare-medicaid-fraud-caseThis is a fraud where services are billed at a higher cost than the original amount. For example a patient might have taken a basic level of treatment and services under it but he might have been billed for a more complex level of treatment and the services are also billed in a more complex way. And again such fraudulent activities take place with the involvement of some physicians as well. It is up to the providers to exercise their duty in a more ethical and legal way.

  • Unbundling:

Unbundling is the process of splitting the services provided as a value package and billing them separately at the highest possible individual costs. This is done in order to get a higher income and in some cases to get a higher reimbursement. Either ways it is purely an unlawful and unacceptable activity by the provider to authorize such illegal activities. Proper bundling procedures should be understood and billing has to be done abiding by the right procedures.

  • Kickbacks:

In simple and in a more raw form, Kickback is nothing but the act of offering/ accepting bribe for an illegal favor taken/provided. This is an activity, under which remuneration in any form is taken for a service such as referring patients for additional services or prescribing a particular medicine, etc., The payment for such acts are usually done under the Government healthcare programs and this is a grave offence and would result in serious legal action.

Such illegal and unethical practices in the field of medicine and healthcare will lead to complete corruption and unfair competition. Moreover Medicine and Doctors are considered as Lifesavers and when such unfair practices take place, then the value, respect and the ethical value of them totally gets spoiled.

In this fast paced world where anything and everything is considered an opportunity for business and monetary gains, the medical field is no exception. Although there are lots of rules and regulations that are in place to curb these Medicaid frauds, it the duty of the patients, providers, physicians and all the others related to discharge their duties with utmost sincerity and honesty.