The majority of medical bills that people in the Sacramento area receive are at least partially paid for through health insurance. Many people have private health insurance through their employer, or they purchase on their own, but there are many others for whom Medicaid pays their medical bills. People may not understand the entire process of how Medicaid pays the medical providers though.
Medical billing relies on the use of codes that state the type of procedure or treatment that was performed during a particular visit. Based on the codes provided by the medical provider, Medicaid pays them a certain amount of money. While that Medicaid payment may not be the entire amount billed, the medical provider needs to accept it. This can be frustrating and lead to certain providers trying to obtain more funds than permitted for the medical procedures they perform.
EXAMPLES OF MEDICAID FRAUD
This can lead to Medicaid fraud, which can occur in many different ways. Some of the common examples of Medicaid fraud include, but are not limited to:
- Billing for unnecessary services or services that were not provided to the patient
- Unbundling – billing separate codes for parts of a procedure that usually is billed as one code for the whole procedure
- Upcoding – billing for more complex procedures that result in higher payments than the procedure that was actually performed
- Kickbacks – paying either patients or others for referrals
Doctors and other medical professionals who are suspected of Medicaid fraud could be charged with a crime. Being charged with Medicaid fraud can have serious consequences, but it does not mean that one is actually guilty. There may be defenses available to those charged. Experienced white-collar criminal defense attorneys understand how to defend against these serious charges and should be consulted at the first indication that a Medicaid investigation is underway.