What are typical Medicaid fraud schemes?
• billing for services not rendered • billing for medically unnecessary services • upcoding (billing Medicaid for more expensive procedures than those that are actually performed) • double-billing (billing both Medicaid and a private insurance company or the recipient directly, or multiple providers billing Medicaid for the same recipient for the same procedure on the same date) • kickbacks (hidden financial arrangements between providers involving some material benefit in return for another provider prescribing or using their products or services, which frequently results in unnecessary treatment) • falsifying cost reports (reimbursement rates for nursing homes, hospitals or clinics depend in part upon the institution’s costs; inflating costs results in higher reimbursement rates)
