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How can I Avoid Medicaid Fraud?

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  • Written By: Ken Black
  • Edited By: Bronwyn Harris
  • Last Modified Date: 19 July 2018
  • Copyright Protected:
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    Conjecture Corporation
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Unlike some types of healthcare fraud, the victims of Medicaid fraud are not individuals themselves, but rather all groups of individuals who pay into the system. In short, this means the taxpayer. Due to the very nature of the program, avoiding Medicaid fraud is not a question needing to be asked to prevent a person from being a victim, but rather from being a perpetrator.

In the United States, the Medicaid program is administered under Title 19 of the US Code and in some cases may be called Title 19 instead of Medicaid. The terms are interchangeable. While it may be possible to steal someone's identity in order to access Medicaid benefits, this is a rare circumstance and can best be addressed by looking at tips to prevent identity theft.

Medicaid fraud is likely the result of one of two scenarios. The first scenario involves those who misrepresent themselves during the application process in order to obtain benefits such as health coverage. The second scenario is the healthcare provider who may submit false claims in order to receive unearned payments from the system.

Often, Medicaid may seem like a good idea for those who are not insured or who are suffering under the challenge of high health insurance premiums. However, income guidelines and other qualification criteria only allow certain people to access the program. A very few who are left out may turn to Medicaid fraud.

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In such cases, those committing the fraud may not report all their income. They may report more dependents than they truly have or make other false statements to make it seem like their income to liabilities ratio is dire. Those who perpetrate Medicaid fraud understand which points are easy for a social worker to verify and which are harder. They then take advantage of that. In order to avoid the appearance or accusation of Medicaid fraud, those applying should be as truthful as possible, taking the time to completely fill out each form as asked.

The other type of Medicaid fraud involves healthcare providers submitting claims for procedures or work not done. This is also done to the Medicare program and even private insurance. If done in a well thought-out manner, this type of scam may be especially hard to catch, especially if the patient is cooperating in the scheme. To avoid being accused of this type of fraud, doctors should take care to document any procedure done very carefully. Having a nurse, physician's assistant, or another partner sign off on any work done provides yet another protection.

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