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Miller Legal LLP
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Washington, DC 20005

Medicaid Fraud Lawyers

Our Medicaid fraud lawyers are dedicated to uncovering fraud against our government so that deserving individuals can continue to have access to the medical care and services they depend upon.

Medicaid is a government program monitored by each individual state to make sure low-income families or individuals with no medical insurance have access to proper medical care. However, thousands of practitioners, healthcare providers, patients and others take advantage of this system every year. In fact, in 2012 a Forbes article stated that the U.S. Attorney General at the time, Eric Holder, suggested that the United States loses roughly $60 to $90 billion every year to Medicaid fraud.

Examples of Medicaid Fraud

The National Conference of State Legislatures gives a brief overview of the issue of Medicaid fraud in the United States, along with a list of the most common forms of fraud committed by providers, patients, and insurance companies:

Provider Medicaid Fraud

  • Submitting a bill for services not performed
  • Billing for the same service more than once ("double billing")
  • Submitting a false diagnosis
  • Performing one service, then billing for a more expensive one
  • Taking kickbacks for patient referrals
  • Providing a non-covered service but billing for a covered service
  • Ordering unnecessary, inappropriate, or excessive tests
  • Prescribing medications which are not medically necessary
  • Prescribing medications for individuals other than the Medicaid patient

Patient Medicaid Fraud

  • Filing a claim for a service or product not received
  • Forging receipts
  • Using Medicaid benefits to obtain medications or products and selling them on the black market
  • Using false information to apply for services or coverage
  • "Doctor shopping"–visiting multiple doctors to obtain prescriptions in greater amounts
  • Using another patient's insurance

Insurer Medicaid Fraud

  • Overstating cost to insurer when paying claims
  • Misleading patients, customers, or enrollees about the benefits of their health plan
  • Undervaluing the amount owed to health care providers under contract
  • Denying claims that are valid

The National Association of Medicaid Fraud Control Units states that other common forms of Medicaid fraud include billing for more hours than there are in the day, falsifying credentials (so that a non-physician may treat patients and bill Medicaid accordingly), substitution of generic drugs but charging for brand-name, and including personal expenses such as the cost of personal items in Medicaid claims.

Fight Medicaid Fraud

Medicaid fraud is not just committed by doctors and insurance companies. We have seen examples of dentists, nursing homes, home health care agencies, drug makers, medical device makers, and other segments of the healthcare industry who have been guilty of Medicaid fraud. When this happens, billions of dollars are stolen from the government and taxpayers every year, and this money could have been used to provide true healthcare services to people in need.

If you believe you have been witness to Medicaid fraud, we can help you conduct a thorough investigation into the matter. As whistleblowers in a qui tam lawsuit, concerned citizens are afforded job protection and may also recover a portion of the money stolen from the government through Medicaid fraud. Please contact us today to learn more in a free and confidential consultation.