Medicaid fraud can affect healthcare providers, taxpayers, and patients. Everyone should be wary of this issue – whether you are familiar with Medicaid or you are new to the program. If you are not careful, you could receive treatments that are totally unnecessary – or even harmful. Patients should also be careful not to engage in any fraud themselves, as this behavior can lead to various consequences. What do you need to know about Medicaid fraud prevention? Can an elder law attorney help you with this issue?
What if I Was Accused of Medicaid Fraud?
If you are a patient and you have been accused of Medicaid fraud, you may not know where to begin. The most common form of patient Medicaid fraud is receiving benefits you are not eligible to receive. All patients should know that Medicaid is a program specifically designed for low-income individuals, disabled people, and similarly vulnerable Americans. If you abuse this system and pursue Medicaid benefits in a fraudulent manner, you could face serious consequences.
According to Health and Human Services, it is illegal to submit fraudulent applications to receive Medicaid. If you knowingly lie or misrepresent facts in your application, you could face serious consequences. That being said, there is a major difference between intentionally lying and simply making a mistake on your application.
Consequences may become even worse if you receive benefits for an extended period of time and the authorities eventually discover that your application was based on a lie. For example, you might claim to be physically disabled. If someone sees you lifting heavy weights at the gym, this could be an example of Medicaid fraud. Prison time is possible for lying on your Medicaid application. That said, the most common consequence is a financial fine. This fine is usually equivalent to the amount of money you fraudulently received from Medicaid.
Patients who conspire with healthcare providers to engage in Medicaid fraud also face serious criminal consequences. If a doctor asks you to lie or participate in a fraudulent scheme to steal money from the healthcare system, you should refuse. While you cannot be held liable for unwittingly participating in these schemes, active involvement could make you a co-conspirator.
Another common type of Medicaid fraud involves identity theft. If you claim to be someone else to receive Medicaid benefits, you may face serious criminal consequences.
Common Examples of Healthcare Provider Medicaid Fraud
The most common examples of Medicaid fraud are committed by healthcare providers. The False Claims Act prevents healthcare providers from defrauding the government with shoddy, overpriced, or non-existent medical services. If a doctor submits one of these fraudulent claims, they may face serious fines and the loss of their medical license.
There are also strict federal laws against kickbacks. The Anti-Kickback Statute prevents doctors from using patients to refer other Medicaid patients. If a doctor offers you money if you refer your friends or family to them, this is likely a violation of federal law. The reward does not have to be cash, and it may include hotel stays, food, and more.
Medical companies are also prohibited from offering doctors compensation for patient referrals. For example, the doctor might receive compensation if they prescribe you a specific type of medication.
Medicaid Fraud Can Seriously Harm Patients
Medicaid fraud doesn’t just enrich criminals – it can also harm patients. A common type of Medicaid fraud involves performing unnecessary treatments to increase payments. Often, these treatments are highly invasive and risky. Patients have lost their lives or suffered life-altering complications because doctors were too focused on defrauding the Medicaid system.
Doctors may also order unnecessary, expensive tests – despite you showing virtually no signs of a particular illness. In addition, healthcare providers may charge separately for treatments that are usually packaged together. This scheme is called “unbundling,” and it can dramatically increase costs.
Recent Examples of Medicaid Fraud
In December of 2024, 20 people in Pennsylvania were charged with Medicaid fraud. The charges involved a home care agency, and the defendants had allegedly sapped millions from the Medicaid program by submitting claims for treatments that were never provided.
In January of 2025, a man in New York pleaded guilty to Medicaid fraud after stealing $700,000 from the system. This individual was providing transport for patients, but he billed each patient for a separate trip – even when patients were transported together in one vehicle.
Also in January, a man in Minneapolis was charged with Medicaid fraud, having allegedly stolen over $7 million from the program by billing for services never provided. The company is accused of billing patients twice for the same services, billing for treatments provided by employers no longer working for the company, and more.
How Can We Fight Medicaid Fraud?
Medicaid and Medicare fraud cost taxpayers almost $150 billion per year. This issue is rampant, and it shows no sign of slowing down. Medicaid Fraud Control Units (MFCUs) help identify fraud – but these units are stretched thin. Inevitably, some healthcare providers and patients get away with Medicaid fraud each year.
From a patient’s perspective, the best approach is to be hypervigilant. If something does not seem right, consider going with a different healthcare provider. If possible, prioritize working with doctors who are cautious about prescribing treatments. If a doctor seems strangely enthusiastic about prescribing many tests, surgeries, and medications, this could be a sign they are defrauding the system. Good doctors always play it safe, and they prioritize the patient’s well-being above their own profit margins.
Can an Elder Law Attorney Help With Medicaid Fraud?
If you are encountering issues related to Medicaid fraud, consider speaking with an experienced elder law attorney for more information. These legal professionals can help those who have been harmed by Medicaid fraud. Lawyers may also help you avoid allegations of fraud if you are not sure how to navigate this system in a compliant manner. Whatever your situation might be, you are not alone. Contact The Elderly Care Law Firm today for further information.
