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Fighting Medicaid Fraud:
Fighting Medicaid fraud has become a vital issue during these days of rising health care costs. Medicaid providers, such as dentists, medical equipment suppliers and even taxi drivers, have been able to defraud millions of dollars from the Medicaid program. They have taken tax dollars from state governments and kept needy people from receiving the medical attention they require and deserve.
What is Medicaid Fraud?
Medicaid providers include hospitals, nursing homes, ambulance companies, doctors, dentists, durable medical equipment suppliers, occupational and physical therapists, speech pathologists, orthotic appliance and prosthetic device suppliers, prescription drug dispensers, podiatric services, laboratory services, vision services, rural health clinics, non-emergency transportation brokers / companies, home health care providers and other suppliers of authorized specialty services.
Whistleblower Rewards for Reporting Medicaid Fraud.
All Activities listed below are violations of various federal and state criminal laws. The False Claims Act (31 U.S.C. Sections 3729-33) allows a private individual or "whistleblower", with knowledge of past or present Medicaid fraud to sue on behalf of the state government to recover stiff civil penalties and triple damages. The person bringing the suit is formally known as the "Relator." If the suit is successful, it not only stops the dishonest conduct, but also deters similar conduct by others and may result in the Relator’s receipt of a substantial share of the state government’s ultimate recovery as much as 30 percent of the total.
If you have reason to believe someone is defrauding any state Medicaid Program or is abusing a Medicaid recipient, it is imperative that you contact the founder of whistleblowerhelpline.com immediately.
Examples of Medicaid provider fraud include:
Billing for services not rendered: A provider bills Medicaid for treatments or procedures which were not actually performed, such as for X-rays and blood tests; for care allegedly given to patients who have died or who are no longer eligible; or for care allegedly given to patients who have transferred to another facility.
Billing for unnecessary services: A provider misrepresents or falsifies a patient’s diagnosis and symptoms on recipient records and billing invoices to obtain payment for unnecessary services, including transporting Medicaid patients by ambulance when it is not medically necessary.
Substitution of generic drugs: A pharmacist fills a recipient’s prescription with a generic drug or an over-the-counter drug but bills Medicaid for a higher cost name-brand drug.
Kickbacks: A Medicaid provider (such as a hospital, a transportation company or a laboratory) offers or pays kickbacks to another Medicaid provider's employees for referring a Medicaid recipient to the provider as a patient or client. A provider (such as a doctor or a hospital) requests and receives kickback payments from Medicaid providers (physical therapists, pharmacies or laboratories) in exchange for referring Medicaid business to the providers. Payments may be in the form of cash, vacation trips, or merchandise.
Double billing: A provider bills both Medicaid and the recipient (or private insurance) for the same service, or two providers bill for the same service.
Other unauthorized billings: A provider charges a Medicaid recipient for a service which is covered by and should be billed to Medicaid, or charges a recipient the difference between the provider’s usual fee and what Medicaid pays.
What is Elderly abuse and neglect?
Physical abuse or neglect is any action or failure to act that causes unreasonable suffering, misery, injury or harm to a Medicaid patient by a healthcare provider. Physical abuse includes anything from striking or sexually assaulting a patient to withholding necessary and adequate food, physical care or medical attention. Financial abuse includes the misuse of a resident’s trust funds to pay for nursing home services already being paid for by the Medicaid program or for uses of a patient’s funds not authorized by either the resident or the resident’s guardian, trustee, administrator, etc.
It is a sad fact that some Medicaid patients, especially the elderly, are physically and sexually abused or neglected by health care workers. In many cases, an abused person is totally dependent on the abuser and is afraid or physically unable to complain.
Warning signs of physical abuse, sexual abuse and criminal neglect:
Cuts, black eyes, bruises and burns, especially when the caregiver cannot adequately explain how they occurred (burns or bruises in an unusual pattern may indicate the use of cigarettes, instruments, or similar items) Patient’s fear of being alone with caregivers. Reports of physical abuse, such as, striking a resident, hitting a resident, kicking a resident, punching a resident, throwing an object at a resident, spitting at a resident, burning a resident, pulling on a part of the resident’s body, any form of retaliation for a resident’s behavior, inappropriate touching of a resident’s body, including touching that is not in the usual course of treatment or care, inappropriately kissing a resident.
Unjustified physical contact involves, but is not limited to:
1.) Excessive force in the course of a prescribed treatment or therapy.
2.) Unnecessary physical contact when providing care, comfort or assistance to the resident.
3.) Retaliation against the resident.
Drug diversion abuse.
Drug diversion is another form of abuse, since it deprives the patient of proper medication. It may also defraud the Medicaid program. Drug diversion includes:
A health care worker throwing away a patient’s medication, selling it or using it himself/herself, a doctor selling prescriptions, a nurse ordering medication for patients without a doctor’s approval.
Patient Neglect
Neglect is the failure of an individual or facility to provide treatment or services necessary to maintain the health or safety of a resident. Neglect includes, but is not limited to failing to provide medical, dental, nursing, physical therapy, pharmacy, psychological, speech or other treatments or services. Failing to carry out care plans or specific treatments, failing to provide for the dietary requirements of a resident and failing to provide safety measures
1.) A 92-year-old resident of a small town nursing home was raped by a male certified nursing assistant. This aide was employed at the facility even though he had a criminal history.
2.) Using a bar of soap that was placed in a sock, an aide repeatedly beat a mentally retarded resident of a human development center because the aide wanted to sit in the reclining chair that the resident was sitting in. After this incident, the facility supervisor violated the law by not reporting the abuse because he simply did not want to fill out the required paperwork.
3.) A convicted felon working at a facility struck a 99-year-old resident in the jaw because the resident was combative.
4.) A 21-year-old male nursing aide was convicted of raping an 89-year-old resident. This female resident had no physical ability to protect herself from this sexually abusive caregiver.
5.) A mentally retarded resident of a human development center was choked by a male aide because the resident would not eat all of his meal.
6.) A female employee of a facility for developmentally disabled children forced a small child to eat his own vomit after the child vomited during his feeding.
7.) On Christmas Day, a nursing home resident was abused by a nurse when the nurse literally jumped on the resident because he failed to comply with the nurse’s orders.
8.) A female nursing aide slapped one resident and spit in the face of another resident because the residents acted in a combative manner.
9.) A male employee of a facility for the mentally retarded forcibly performed oral sex on a mentally retarded male resident.
10.) While angry at a combative resident, a female nursing aide choked a different resident in an effort to take out her frustrations against the combative resident.
Examples of Abuse cases.
1.) A nurse failed to give tube feedings and medication to an elderly resident as ordered by a physician. The resident had no other way to receive any sustenance.
2.) A nurse gave two residents ten times the amount of insulin ordered by the physician. This massive overdose resulted in the death of one of the residents and the hospitalization of the other resident.
3.) A female resident was forced to lie in her own feces after an aide refused to help the resident from the bed into a "potty chair." The aide even ridiculed the resident after she soiled herself.
4.) A mentally retarded resident of a human development center was left in his own feces after a male aide refused to clean the resident. The aide then hid this fact from other employees. The feces, which was spread all over the back, legs, and head of the resident, was allowed to dry before the resident was cleaned.
5.) A female nursing aide was captured on videotape dumping out trays of food meant for residents because she did not want to take up any of her time feeding the residents.
6.) any residents of a nursing home went for weeks without their vital signs and blood pressure taken because an aide did not want to properly do her job. She stated that the vital signs did not have be taken because the residents were eventually going to die, whether she took the vital signs or not.
Whistleblowing Reporting of Suspected MediCaid Fraud
If you have reason to believe someone is defrauding MediCaid, simply click on the link below in red for a free case evaluation. If you believe you have a whistleblower claim simply click on the link below in red for a free case evaluation. Any and all information provided to Whistleblower Rewards Network will be kept strictly confidential and will be for the use of our designated attorneys, our investigating agents and the appropriate state and or federal government agencies. Whistleblower Rewards Network strictly prohibits the dissemination, distribution or copying of your information to any unauthorized outside parties.
