Insurance & Medicaid Fraud
Do not be deceived into thinking that insurance and Medicaid fraud are minor issues. Not only does law enforcement pursue these crimes vigorously, but costs our nation billions of dollars. Every year the insurance industry spends millions of dollars to help authorities catch those involved in insurance fraud. If your clinic is involved in Medicaid fraud, your future is in jeopardy. The United States Department of Justice has made prosecuting this crime one of its top priorities. Make no mistake, people go to jail for insurance fraud.
The following questions should help you determine whether this crime is being committed in the clinic where you work. Yes answers should be seen as red flags. (Note that insurance fraud is often accomplished by using some of the same techniques as Medicaid fraud.)
- Are non-Medicaid patients ever allowed to use another person’s Medicaid card?
- Are procedures performed on one patient ever billed to another person’s insurance company?
- If insurance of Medicaid is paying for an abortion, are gestational ages ever exaggerated in order to justify higher billing rates?
- Are insurance companies ever billed for services that were never provided (STD testing, STD treatment, ultrasound, etc.)?
- Does the clinic ever charge a patient for an abortion, and then also bill her insurance company or Medicaid for the same procedure?
- If a patient’s insurance policy doesn’t cover abortion, does the clinic take her insurance information anyway and then bill her insurance company for the component parts of the abortion? For example, do they trick the insurance company into paying for an office visit, internal exam, sonogram, counseling, vaginal swab, cervical dilation etc.? (This “unbundling” scheme almost always results in a bill to the insurance company that far exceeds the amount that cash-paying patients are charged.)
- If a patient’s insurance policy or Medicaid doesn’t cover abortion, does the doctor ever cause what appears to be a spontaneous miscarriage and then bill for performing a D&C? For example, are Medicaid patients ever given a drug or a laminaria insertion with the intent of producing what appears to be a spontaneous miscarriage so that a D&C can be performed and billed to Medicaid?
- In circumstances where Medicaid does not pay for abortions, are Medicaid patients ever offered a discount for providing their Medicaid cards to the clinic? This may indicate that the clinic is going to “unbundle” the procedure and charge Medicaid for the component parts. In other words, instead of charging Medicaid for an abortion, they will charge for ultrasound, vaginal swab, cervical dilation, etc. It could also indicate that they are going to bill Medicaid for services that were not provided (STD testing, STD treatment, ultrasound, etc.).
If your clinic is involved in Medicaid fraud, your future is in jeopardy. The United States Department of Justice has made prosecuting this crime one of its top priorities.