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.
Most people are aware of the most obvious VA benefits – things like healthcare and education. However, this program offers many other benefits that may be less obvious to the average veteran. If you have served our nation in the military, it always makes sense to take full advantage of everything the government offers you in return for your service. These hidden VA benefits could have a real effect on the quality of your life, and they may depend on your unique circumstances – including your location. It may help to discuss the less obvious benefits of VA alongside an experienced VA benefits lawyer.
Various Discounts
One of the most understated VA benefits is the discounts you will enjoy as a veteran. When making virtually any purchase, you should ask whether the company offers discounts for veterans. These discounts can be quite significant, and they can help with rising living costs.
For example, Staples offers a ten percent discount to veterans for most items. You can also find discounts at theme parks and many other establishments throughout the entire nation. Another major benefit is free parking, and you may be able to park without paying in a number of locations with your veteran status. However, it is important to put proper markings on your vehicle to enjoy these benefits (such as veteran plates and special parking passes).
Access to the Entire VA Healthcare Network
Many veteran patients assume that the VA network only includes healthcare providers in their home state. However, the VA network encompasses the entire nation. While the general population might be limited to providers in a much smaller network, you could potentially travel to an entirely different state for certain medical treatments.
For example, there might be a world-class spinal surgeon in California. If you live in Florida, you may be able to book your surgery with this surgeon with relative ease through VA healthcare. This logic applies to many other types of experimental and innovative treatments only found in other states.
Pregnant Veteran Benefits
The VA program recognizes that many of its service members may eventually become pregnant. If you are planning to get pregnant or you are already pregnant, you might want to take advantage of the various VA healthcare benefits specifically geared toward pregnant people. This may make your pregnancy much easier and more affordable than you realize.
Free Hunting and Fishing Licenses
Florida offers veterans free hunting and fishing licenses. This is a major benefit for many veterans who like to fish or hunt for their own food. Veterans tend to enjoy hunting, and a free license could provide years of recreation and sustenance. Note that in many other states, veterans still have to pay for their hunting and fishing licenses at a discounted price.
VA Benefits for Aging in Place
If you plan to age in place, you should explore the various VA benefits associated with your planned retirement. These benefits may make it easier to remain in the comfort of your own home for longer periods without moving to a nursing home. This is a major priority for most retirees in Florida, and VA healthcare benefits can make a real difference.
Specific benefits include nursing care, physical therapy, and assistance with daily tasks. Adult Day Health Care is also quite popular among retired veterans, and it provides an opportunity to socialize with other veterans like you. During these daycare sessions, you can participate in activities, enjoy health services, and enjoy your twilight years to the fullest.
Free College for Purple Hearts Recipients
While many are familiar with the various educational VA benefits, some might be unaware of the specific benefits offered to Purple Heart recipients in Florida. The Sunshine State essentially pays for your entire undergraduate degree if you have received the Purple Heart (or an award superior in precedence). Note that you do not necessarily need to attend a community college or state university to enjoy this benefit. You can also attend more practical training, perhaps while earning your trade certificate.
You should also know that your children may qualify for educational VA benefits even if you neglect to take advantage of them. This could provide your children with an excellent education without excessive costs for your family. College tuition has reached extremely high levels across the nation, and it always makes sense to get help when saving for this expense.
Access to Commissary and Exchanges
Service members often shop at the commissary and exchange, which provides low-cost food, clothing, and other items. This is essentially a retail store set up by the military. Although it operates for a profit, these profits generally go toward supporting the military community.
Many veterans do not realize that they can continue to access commissaries and exchanges even after they retire from military service. Like many other hidden VA benefits, access to a local commissary can help address the rising cost of living in many states – including Florida.
How to Fight for Your VA Benefits
If you are experiencing any challenges in accessing your VA benefits, you have every right to push back. If the VA itself seems unresponsive or refuses to help you access these benefits, you can take your complaints to the VA White House Complaint Line. You might also consider working alongside a VA benefits lawyer to ensure access to the most important benefits.
Can a VA Benefits Lawyer Help Me?
If you want to get the most out of the VA program, consult with an experienced veterans benefits lawyer. We understand how difficult it can be to navigate this program, and they can guide you toward positive outcomes. While online research can provide a basic overview of VA benefits, you may need to consider your own unique circumstances to get the most out of this program. Schedule a consultation with the Elderly Care Law Firm today, discuss your priorities, and pursue the most appropriate benefits with confidence.
Beneficiaries may encounter many new phrases when navigating Medicaid, and “managed care” may seem confusing at first. However, the underlying concepts are quite simple – and it may only take a few minutes to become confident about how managed care works. Simply put, managed care refers to the manner in which your loved one receives healthcare services. The government refers to this as a “health care delivery system” that involves budgeting, quality control, and other organizational steps. The type of managed care depends on your home state, and it may be difficult to create a targeted strategy without help from an experienced elder law attorney.
What Exactly is Managed Care, Anyway?
Managed care is the method by which states provide eligible people with Medicaid benefits. The process involves contracting a private insurance company to provide health care services, and the company receives a certain amount of money each month in return.
Although this might seem pretty simple, the Commonwealth Fund notes that managed care can be “extraordinarily complicated” in many areas of the country. Managed care is now the most common way in which beneficiaries receive healthcare benefits. In 1990, only 10% of eligible recipients enrolled in managed care – but now that number has risen to well over 50%.
Managed Care vs. Fee-for-Service
Fee-for-Service (FFS) is the alternative to managed care. Under FFS, the state compensates the healthcare provider for each service you receive. Many beneficiaries are not aware that there are two different systems when it comes to Medicaid. The differences between these systems are somewhat controversial, with many arguing that one is superior to the other. For example, some point out that under FFS, beneficiaries can choose their own specialists. On the other hand, they could be charged for visiting the ER if it was not a true emergency. While the pros and cons of FFS and managed care represent a completely different topic, beneficiaries should know that they at least know that they may have a choice.
Understand the Costs Involved
It may help to sit down and discuss the various costs involved with managed care. Typically, managed care plans are cheaper compared to FFS – especially if you choose a Health Maintenance Organization (HMO). These organizations help limit costs while ensuring high-quality care – a difficult balancing act that does not always turn out well.
In the end, each beneficiary has unique priorities and needs when it comes to healthcare – and it will be difficult to navigate managed care effectively without a solid understanding of your own needs. Remember, part of this planning process involves treatment that you may need at some point in the future.
It may be helpful to discuss these potential future needs alongside your doctors. Pay close attention to genetic conditions that your family members may have. Consider your current health limitations and how they might degrade or improve in the future. After this discussion, you can take what you’ve learned to your elder law attorney. Your lawyer can then help you determine the most appropriate path forward.
Understand the Focus on Preventative Care
If you choose managed care, you should understand that this system focuses considerably on preventative care. This is part of the cost-limiting strategy, but it can also help you avoid preventable health concerns. It might seem like this is simply to lower costs for the insurance companies, but all doctors understand that preventing illnesses makes much more sense compared to treating them after they appear.
As a result, you may be encouraged to get annual check-ups. You might also be encouraged to take vaccines. Screenings may also become more frequent as you age, and this is something you should probably make time for.
Consider Your Health Network
If you choose managed care, you might want to consider your health network and the quality of healthcare in your specific state. It is no secret that some states have better healthcare systems than others, and it may make sense to relocate in order to take advantage of this. Each state has its own specific Medicaid network and program, and you may need to research these differences before your move.
You can also target specific states for other benefits, including homestead exemptions and lower tax rates. An elder law attorney may be able to help you choose the most optimal state based on your unique retirement needs. Finally, it is worth noting that not every state offers managed care plans. If you live in a state that does not offer managed care plans, you might need to relocate before you even consider this option.
Dual Eligibility and the Danger of “Fragmented Care”
If you are eligible for both Medicaid and Medicare, it might be more challenging for you to navigate this process compared to others. There is a real danger of receiving “fragmented care” due to the lack of integration between these two programs. However, various states and insurance providers are attempting to address these issues for dual-eligible seniors.
You might be able to find an “integrated care plan” that serves only dual-eligible people in your community. Often, these plans cater to people in nursing homes. Because these organizations focus on dual-eligible individuals, they can integrate and coordinate their treatment with greater efficiency. Speak with your elder care lawyer to learn more about integrated care plans.
Contact The Elderly Care Law Firm Today
Medicaid planning can be challenging if you are working alone. You may feel intense pressure to provide your loved one with effective healthcare services, and it may feel like this task has become a full-time job. Fortunately, you can delegate many aspects of Medicaid planning to an experienced elder law attorney. During your first consultation with one of these legal professionals, you can discuss how your specific state handles managed care. You might also discuss your senior’s unique challenges and priorities. From there, you can ensure your loved one receives the best health care possible. To get started, consider a consultation with The Elderly Care Law Firm today.
One of the most confusing aspects of Medicaid is its varied nature. Depending on your state of residence, you might have to approach Medicaid with all kinds of different considerations. One of the most controversial and complex aspects of this is “Medicaid expansion.” While this might be a difficult concept to understand, the most important thing to remember is simple: Some states have expanded Medicaid, while others have not. The impact of this could affect seniors and low-income individuals in various ways. Read on to learn more.
What is Medicaid Expansion, Anyway?
To understand Medicaid expansion, you first have to understand the “eligibility requirements” for this federal program. Different States may determine eligibility in different ways. Some consider multiple factors, including income, the number of people in your family, your disability status, and others. Other states take a simpler approach, and they only consider your income.
The states that only consider your income level when determining eligibility are said to have “expanded Medicaid coverage.” By enforcing fewer eligibility requirements, more people qualify for Medicaid. In other words, Medicaid is expanded to include more people.
If your state has expanded Medicaid coverage, you only need to consider one metric: The federal poverty level. As long as your household income is below 138% of this number, you automatically qualify for Medicaid with no further steps required.
What is the Impact of Medicaid Expansion?
According to the Center on Budget and Policy Priorities, expanding Medicaid has had various effects. Statistics show that when states expand Medicaid, adults are more likely to seek insurance coverage. States also see a rise in mental health outcomes and a reduction in opioid overdose deaths. Some studies indicate a reduction in overall depression rates for states that expand Medicaid. Some say that hospitals have become more financially sound in States that have expanded Medicaid.
That being said, Medicaid expansion has its fair share of critics. One study found that in states with expanded Medicaid, low-income women had fewer live births. Other studies suggest that expanded Medicaid may be correlated with poor infant and maternal health.
Some say that Medicaid expansion has forced some Americans off their private insurance policies. These critics claim that if Medicaid expansion spreads to other states, some may have no choice but to go on welfare. They also note that welfare pays less than Medicaid. There is some indication that States that expand Medicaid later could face increased negative effects.
In 2022, Forbespointed out that providers may be less willing to accept new Medicaid patients compared to privately insured patients. In some states, wait times for Medicaid patients are longer. Forbes also points to a study that found Medicaid patients were 50% more likely to die from throat cancer compared to privately insured patients.
How Does Florida Approach Medicaid Expansion?
Florida is one of the many states that has not expanded Medicaid. This is a hot-button issue for many residents, especially those who want to benefit from increased eligibility seen in other states. Others are wary about the potential negative effects of expansion – particularly residents with private insurance.
So far, Governor DeSantis has been less than enthusiastic about Medicaid expansion. However, he has justified this stance on relatively few occasions. The cost could be considerable. Florida is famous for its high population of seniors, and Medicaid expansion could affect the Sunshine State in ways not seen in other jurisdictions.
The Paragon Health Institute argues that 30% of Florida residents would be on Medicaid, stretching an overwhelmed healthcare system. Taxpayers would reportedly have to pay a $2 billion bill for Medicaid expansion over the following decade, and this may cause the State to raise its taxes or cut other programs in order to compensate.
That being said, many argue that voters in Florida should at least get a chance to decide on Medicaid expansion. There is a growing legal battle to put Medicaid expansion on the ballot, and this could happen sooner than many realize. If Medicaid expansion goes on the ballot, there is a high chance of it being approved in Florida. In every other state, Medicaid expansion has been greenlit after reaching the ballot. People tend to vote for Medicaid expansion if they get a chance.
Currently, seniors may qualify for Medicaid in Florida if their income is below approximately $3,000 per month. They must also have assets below $2,000, and they must need nursing home services.
Can a Medicaid Lawyer Help?
If you are living in Florida or another state that has yet to expand Medicaid, legal assistance may help you qualify. Even if you do not quite meet the requirements for Medicaid, you might be able to adjust your financial affairs slightly and re-apply.
The best strategy depends on your unique circumstances. In some situations, the most appropriate course of action might be to take advantage of the Florida Medicaid home exemption. In other situations, you might want to explore strategies involving your spouse.
It may be easier to qualify for Medicaid than you realize. Alternatively, there may be other sources of financial support to explore. For example, you might pursue compensation for medical treatments under VA benefits if you are a veteran. Lawyers are familiar with these various programs, and they can help you pursue fair compensation based on your unique circumstances.
Contact The Elderly Care Law Firm Today
If you are ready to have a more detailed discussion about Medicaid expansion, why not schedule a consultation with The Elderly Care Law Firm? Our experienced Medicaid attorneys can help you assess your next steps, depending on your state’s approach to Medicaid expansion. If there is one thing you should take away from this article, it is that the best Medicaid strategy in Florida depends entirely on your unique circumstances. Reach out today to discuss these circumstances in more detail – and get started with an action plan.
Many veterans learn all kinds of tips, tricks, and “life hacks” thanks to their military service. During a deployment, a soldier might learn various mechanical skills. They might learn how to defend themselves in a dangerous situation. For many veterans, a general sense of discipline is one of the most valuable rewards of service. When it comes time to apply for VA benefits, you may benefit from additional tips and tricks during the application process. Once you learn about these tips and tricks, it might be easier to get the most out of your VA benefits. For more guidance on VA benefits, consider a consultation with an elder law attorney.
Review Your Discharge Papers Before Applying
Before you begin, you might want to review your discharge papers. Look for something called a “DD-214,” which details the circumstances of your discharge. If you do not have your DD-214, you can request a copy from the National Archives. This might be something that a lawyer can assist with if you are not sure how to proceed.
Why is your DD-214 necessary if you want to apply for VA benefits? The truth is that not all servicemembers get access to VA benefits. If you received a “dishonorable discharge,” you might not be eligible to pursue these benefits at all. That being said, you might still gain access to these benefits even if you were dishonorably discharged. If you review your DD-214 and determine that your discharge was not honorable, speak with an experienced lawyer. Pursuing VA benefits may be possible – but it makes sense to review your situation in more detail before moving forward with your application.
Gather Additional Documents
Before you get started with your application, you might want to gather as many relevant documents as possible. It makes more sense to gather these documents together before starting on your application. Otherwise, you will have to stop filling out your application as you periodically search for the information you need. Other than your DD-214, necessary documents might include marriage certificates, divorce decrees, income statements, tax returns, and healthcare provider info.
If you’re not sure what kind of documents you need before starting your application, speak with an experienced lawyer. The necessary documents may vary depending on your unique situation – especially if you are applying for a widow’s pension.
Consider Keeping a Journal
As you approach your new application, you might want to write a journal. This could be a positive move if you are applying for VA medical benefits. A journal can help you document some of the less obvious psychological effects of a serious injury. Don’t be afraid to express your feelings in these journal entries. As long as you make your entries at the same time as your treatment, they can support your application – and they might increase the chances of positive outcomes.
A journal could be particularly useful if you’re applying for PTSD-related benefits. In addition, journal entries could help you recover benefits for mental health issues caused by head injuries.
Review Your Medical Records
As a general rule, it makes sense to carefully review your medical records before starting your VA benefits application. It may be difficult to apply for the appropriate benefits if you are not totally confident about your medical condition(s). Consider requesting copies of your medical records and have them at your side as you fill out your application.
It is all too easy to write incorrect information when filling out these applications. Be as specific as possible – and write down the official medical term for your injuries. For example, you should write “femur fracture” rather than “broken leg.” You might also want to spell out acronyms. For example, you would write post-traumatic stress disorder rather than “PTSD.”
Be Prepared to Reveal Family Information
Although it might seem awkward, these applications require you to reveal considerable details about your family information and history. The VA needs to know about all of your previous marriages, and you will need to list the names and relevant information of prior spouses. If you have a current spouse, they might also need to list their own prior marriages. This section alone can take hours to complete if both spouses have had numerous previous marriages.
You might also need to reveal the names and information of your children. Rest assured that the VA is a reputable organization, and they will not share this sensitive information with others.
Take Your Time
Although it might seem tempting to rush through your VA benefits application, it makes more sense to take your time. A single mistake could cause your application to be denied – and this may cause needless delays. If you urgently need VA benefits, it makes even more sense to slow down and double-check your application before sending it. Rushing will not get you anywhere, and it may push you several steps backward. If you are worried about potential mistakes on your application, have a lawyer check it over first.
Consider Expediting Your Application It is possible to expedite a VA benefits application in certain circumstances. Generally speaking, expedited applications are reserved for those who need them most. These might include terminally ill people or those who desperately need life-saving treatment. If you think that you might fall into one of these categories, discuss the possibility of an expedited application with your lawyer.
Consider Adding Supporting Statements
According to the VA, supporting statements can help your application. These statements should come from reliable third parties, such as friends, family, or the military servicemembers you served alongside. Supporting statements can shed further light on your claimed condition(s), and they can improve the chances of an approved application.
Contact the Elderly Care Law Firm Today
If you are serious about getting the most out of your VA benefits, contact the Elderly Care Law Firm today. Located in Miami, our law firm has been helping seniors and veterans for years. We know how crucial VA benefits can be, and we can guide you through the application process with confidence and efficiency. Remember, online research is only the first step – and you can continue this important discussion during a meeting with us. Book your consultation today to get started.
