What Is Medicaid Fraud?

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Medicaid Fraud Overview

Medicaid fraud includes any action that attempts to defraud the Medicaid healthcare program. These fraudulent actions can be taken by doctors, hospitals, pharmacists, and other providers who make claims to Medicaid as a result of their profession.

Fraudulent Medicaid claims can allow parties to recover more money from the government than they should. Healthcare providers may commit Medicaid fraud in the following ways:

• Billing for unnecessary services;
• Billing for services that were not performed;
• Billing with multiple insurance codes instead of using the cheaper, global insurance code;
• Billing for services at a higher level than what was provided;
• Writing unnecessary prescriptions;
• Offering special, kickback benefits for beneficiaries who refer other Medicaid patients;
• And more.

Whistleblower Lawsuits

Individuals who work for a company, organization, or person that is committing Medicaid fraud may be able to file a whistleblower lawsuit based on their insider knowledge.

Whistleblower lawsuits allow individuals to take legal action on behalf of the federal government, often by bringing their allegations under the False Claims Act. These lawsuits allow for a positive resolution for both the government and private individuals who take legal action on the government’s behalf. Whistleblower suits can be lucrative to plaintiffs, who can recover thousands of dollars in compensation by participating.

Medicaid Fraud Settlements

By participating in a whistleblower lawsuit against a fraudulent party, individuals may be able to collect a portion of any recovery that is paid to the government. If individuals participate in a whistleblower lawsuit that ends in a government settlement, they may be able to collect between 15 and 30 percent of the recovered compensation.

In 2019 alone, there have been numerous Medicaid fraud settlements totaling millions of dollars through which whistleblowers have been able to collect compensation.

In February 2019, Walgreens agreed to pay $269 million to the federal government to resolve claims that the pharmacy defrauded Medicaid by overcharging for certain drugs and supplies. The claims were brought by two former Walgreens employees who “blew the whistle” on the pharmacy’s allegedly fraudulent behaviors.

In March 2019, a smaller but still substantial whistleblower lawsuit was settled for $18 million. The deal resolved claims that Vanguard Health Care in Tennessee defrauded Medicaid by billing for services that were never actually provided for patients.

In June 2019, two health care providers from Massachusetts agreed to pay over $10 million to resolve Medicaid fraud claims against them. The two providers were accused of false billing practices that result in fraudulent claims to Medicaid.

When To Speak To A Qualified Medicaid Fraud Attorney

If you believe you have witnessed Medicaid fraud, you may be able to file a whistleblower suit against the organization, pharmacy, or healthcare provider guilty of fraud. An experienced Medicaid attorney can help evaluate your situation and assist you in putting together a whistleblower lawsuit.