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Understanding Medicaid Fraud in Ohio

June 30, 2016 | Written by Dan Margolis

There are many different ways that a health care practitioner could be found to have committed health care fraud in Ohio. According to the FBI, medical fraud is something that the agency takes seriously. The FBI works with other state and local law enforcement agencies to find those who engage in health care fraud, which includes Medicaid abuse.

Medical professionals or staff could be charged with a crime if the FBI determines that patient information was stolen, copied, transferred or sold to others for the purpose of committing medical fraud. Additionally, it is illegal for parties to obtain information through the same methods. It is also against the law for medical offices or people to encourage patients to visit a specific clinic with the promise of a gift or even money.

Medicaid abuse is another area where some medical practices may commit fraud, according to the Ohio Attorney General. In practice, those eligible for Medicaid visit doctors and other licensed health care practitioners and facilities, which are then reimbursed by the program. Taxpayers pay for Medicaid, which has an annual cost of $15.4 billion. This money is meant to help those in a lower income bracket afford health care, but some doctors may take advantage of the system to increase their income.

There are many different ways that Medicaid fraud might exist. For example, a medical professional could be found guilty of fraud if the professional reduced his or her service quality or billed for a service that was never given. Providers are not allowed to accept rebates or kickbacks for their services or charge co-pays for those who are eligible for Medicaid. Other falsified requests for reimbursement, including billing separately, rather than together, in order to increase the amount reimbursed, also constitutes fraud under current laws.

Additionally, fraud occurs when providers request reimbursement for services to patients who do not fall under the Medicaid program. It is against the law as well, for doctors to submit falsified documentation with a Medicaid claim. Doctors found duplicating bills to get paid twice or who increase the cost of a service in order to receive additional money may be charged with committing fraud. Providing a patient with generic drugs while billing the Medicaid program for premium drugs in order to pocket the difference is also illegal.

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