Understanding Medicaid Fraud: Types, Examples, and Consequences

Medicaid fraud is a serious offense. There are a variety of ways that a medical provider can be caught up in Medicaid fraud. Some of these examples take advantage of the government and some take advantage of Medicaid beneficiaries.

Billing Issues

• Billing issues include a provider billing Medicaid more than once for the same service, a provider billing Medicaid for a service that was not provided to the recipient and a provider falsifying health information in order to bill Medicaid for services that are not really necessary.

Unnecessary Charges

• Unnecessary charges include a provider charging a Medicaid beneficiary more than they usually charge other patients or a provider billing a beneficiary for the difference between the provider̵7;s usual charge and the amount they are paid by Medicaid.

Substitutions and Kickbacks

• Substitutions and kickbacks include things like a pharmacy giving a recipient a generic drug, but billing Medicaid for the brand name version or a provider receiving cash or other gifts for referring beneficiaries to particular specialists.