Medicaid is a federal individual-qualifying health insurance program. The program assists individuals that may be having difficulties paying for their medical costs. Although it sounds a lot like the similarly named Medicare, there are differences between the two.
Medicare and Medicaid are both federal systems that offer medical assistance and services to low-income individuals and senior citizens. Medicare, however, is fully federal government-funded. It is available to people that are at least age 65 or older.
Medicaid is administered by the federal as well as the state governments. In contrast to Medicare, anybody can receive Medicaid regardless of how old they are. Typically, Medicaid is open only to individuals and families with low incomes.
Various methods may be used for committing Medicaid fraud. People may perpetrate Medicaid fraud via deceitful claims, requesting money from people for services, or making deceitful declarations about income and expenditure. Even doctors may be accused of Medicaid fraud. The licensed medical staff may be guilty of fraud if they accept bribes, refer patients for benefits, or try and obtain money from others for Medicaid or Medicare services.
Much money funnels through Medicaid programs. It can be tempting to commit fraudulent schemes for personal benefit. Medicaid fraud is not something to be taken lightly, though. You may be convicted both at the state and federal level on felony charges.
When it comes to Medicaid fraud, Florida is distinct in that it has its own series of laws. The law states that you cannot do the following:
- Make any untrue statements or exclude any statements in any claim against Medicaid or Medicare.
- Create dishonest claims for goods or services that Medicaid did not authorize.
- Charging, soliciting, or accepting items of value for a Medicaid service.
- Failure to give the agency credit for whatever payment a third-party source may have given you.
- Making false statements regarding income and expenditure documents.
- Requesting, accepting a bribe, or being recompensed for a healthcare practitioner or facility referral.
- Requesting, accepting a bribe, or seeking to be recompensed for Medicaid services and goods.
- Sending information that is deceptive to be recognized as a Medicaid provider.
- Using the identification number of a Medicaid provider or beneficiary to make a claim for products or services not allowed to be reimbursed by the system.
Healthcare fraud is highly lucrative, as many people have made thousands or millions of dollars through potentially illegal or deceptive practices. Healthcare fraud, however, also has grave consequences, including prison time, probation, hefty fines, and negative consequences when it comes to immigration.
Depending on the severity of the fraud crime, a defendant may be sentenced to several years in prison or fines of more than $20,000. However, there are legal defenses when it comes to Medicaid fraud. A lack of knowledge is one of several defense examples. The federal government has to show that you entered a scheme to defraud it "knowingly." In addition, the attempt to defraud must have been willful. If you had no intention of defrauding or you had no knowledge of the defrauding scheme, you may have a legal defense.
The general information provided above about Medicaid fraud in Fort Lauderdale is meant for educational purposes only and is not a substitute for speaking directly with an attorney about the facts and circumstances of your case. Please call 954-500-0003 in Broward or 305-674-0003 in Miami to schedule a consultation with the Law Offices of Mark Eiglarsh.