Who can be accused of Medicaid fraud?

Medicaid is a government program that is administered by both federal and state agencies. While Louisiana provides guidelines on how a person may qualify and apply for Medicaid benefits, the federal government helps fund the program to ensure that individuals with low or limited financial means are able to access health care services. As with many other government-run programs, there are, in some cases, situations where individuals face accusations of improperly using or benefiting from Medicaid services.

Recipients of Medicaid benefits can be accused of Medicaid fraud if they do not actually qualify for the provided benefits, but more commonly health care providers are the individuals identified for breaking the program’s rules. Doctors, hospitals and insurance providers may face fraud claims for a variety of reasons.

Health care providers may be accused of committing Medicaid fraud if they bill the program for services that they did not actually provide to Medicaid recipients. In some cases, an accidental billing entry may lead to the double billing of a Medicaid service; these incidents can lead to reports of Medicaid fraud.

Additionally, health care providers may face Medicaid fraud claims if they bill the program for tests and other services that are unnecessary for their patients’ care. These claims can be erroneous, as in many cases a doctor or other health care professional must utilize a variety of diagnostic tests in order to determine the type or extent of ailment that a patient may suffer from.

Accusations of Medicaid fraud can be damaging to a health care provider’s practice. While in some cases fraud does occur, in others doctors and other practitioners are pulled into Medicaid litigation over mistakes or misinterpretations.

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