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The Serious Consequences of a Medicaid Fraud Investigation

 The state of Florida will receive $300,000 from the settlement of a Medicaid fraud case spanning numerous states. Naples News is reporting that a Cincinnati-based pharmacy provider recently reached a multi-million dollar settlement with case plaintiffs. As compensation for incidents are occurring within the state, the Florida Attorney General is reporting that the state was awarded a portion of the settlement amount. This is one of many cases resulting from ongoing efforts by state and federal officials to crack down on instances of Medicaid fraud. Since 2011, Florida’s Medicaid Fraud Control unit has been responsible for more than $450 million in settlements and court awards. While this accomplishment is impressive from the government’s perspective, it also represents the amount of citizens who must fight against Medicaid fraud allegations.

What is Medicaid Fraud and What are the Penalties?

Medicaid fraud is generally defined as the provision of false information to the government for the purpose of receiving medical reimbursements and payments. Allegations are treated seriously, often resulting in investigations by state and federal agencies. Authorities will review financial records, communications and patient medical records towards the goal of proving guilt. The process is very intrusive and often stressful on the accused. For that reason, individuals should quickly seek the assistance of an experienced attorney upon initial knowledge of a pending investigation.

Due to the involvement of a federally funded program, Medicaid fraud is usually classified as a federal offense. This means that a defendant can face state and/or federal prosecution. If guilt is proven, the resulting penalties can include substantial fines and federal imprisonment. A conviction under the False Statements Act can result in a $10,000 fine and five years in prison. Mail fraud convictions, which often accompany Medicaid fraud cases, can lead to $1,000 fines for each incident and up to five years imprisonment. The seriousness of these penalties exemplify the vital importance of adequate representation.

Types of Medicaid Fraud Allegations

In the pharmacy provider case, the involved states alleged that the company provided illegal financial incentives to a number of skilled nursing homes. According to reports, the facilities returned the favors by consistently utilizing the company for the provision of medications to Medicaid patients. The pharmacy company was accused of violating the federal government’s Anti-Kickback statute, which was created to prevent improper influence in the selection of healthcare providers. The pharmacy company is also reportedly accused of filing false Medicaid claims within numerous states.

Medicaid fraud allegations are possible against companies, as in the above referenced case, or individuals. Aside from kickback accusations, other Medicaid fraud allegations include:

  • Billing for services that the patient does not need;
  • Billing for services the patient never receive;
  • Billing for the same service more than once;
  • Improperly coding procedures to more expensive services;
  • Selling legally obtained prescriptions for profit; and
  • Submitting falsified prescriptions.

If you or a loved one is facing a Medicaid fraud investigation, contact the capable attorneys of Ratzan & Faccidomo, LLC in Miami today at (305) 330-3905 for a confidential and free consultation.

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