Do You Have Evidence of a Medical Provider Committing Medical Necessity Medicaid Fraud?
State False Claims Acts are violated when a dentist, physician, mental health professional or other Medical provider or Medical facility (hospital, clinic, pharmacy, nursing home, home care agency, medical transportation company, durable medical equipment company, pharmaceutical company) submits a claim to Medicaid for medically unnecessary products or services to benefit financially.
If your employer or other medical provider is guilty of medical necessity Medicaid fraud, you might be eligible for a money reward from your state for exposing the fraud.
Common Medical Necessity Fraud Schemes that Violate Medicaid False Claims Laws
If you have information regarding a violation of the False Claims Act through fraudulent billing practices, you may be entitled to a large cash award for reporting fraud. Typical medical necessity fraud schemes that Medical providers use to defraud state Medicaid programs include:
- Billing for medically unnecessary services: Billing for diagnostic procedures, treatment protocols, pharmaceuticals, or medical equipment that are not medically necessary for the recipient.
- Billing for medically unnecessary transportation: Transporting patients to treatment centers when the passenger is able to be transported via public transportation, taxi or personal vehicle.
- Falsifying documents: Misrepresenting diagnoses or symptoms, altering dates or times, forging signatures, or signing regulated documents by unlicensed nurses or staff in order to imply medical necessity.
- Misrepresenting diagnoses or symptoms: Recording non-existent or exaggerated patient symptoms or diagnosis in order to bill Medicaid for treatments, laboratory work, diagnostic tests, x-rays, medical devices or pharmaceuticals.
Whistleblower Cash Rewards are Available for Reporting Medical Necessity Fraud that Cheats Medicaid
Many states have what are called False Claims Acts that make cheating the state illegal. Highest among the rates of fraud is Medicaid Fraud and these laws have whistleblower rules that call for cash rewards of up to 30% of any amounts recovered to be paid to people who report Medicaid Fraud.
Also, whistleblowers reporting illegal acts that harm Medicaid by their employer or other medical provider, are protected from losing their job by strong anti-retaliation provisions of their state False Claims Act. It’s illegal to fire an employee for reporting healthcare providers who are cheating Medicaid.