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Robert S. Toale Motto
  • New Orleans Criminal Defense Attorney

What is Medicaid fraud and how is it investigated?

Medicaid is a government program that offers health care coverage to individuals and families who fall into low income brackets. People eligible for Medicaid can receive coverage through the program for free or may be required to pay small fees in order to receive benefits. Many individuals throughout Louisiana receive Medicaid assistance based upon their legitimate financial needs.

Unfortunately, some people intentionally or accidentally receive Medicaid assistance even when they do not qualify under the program’s federal and state requirements. Receiving Medicaid when one does not qualify can constitute Medicaid fraud. Like any other form of fraud, Medicaid fraud can involve expressly claiming a right to Medicaid or intentionally omitting information that disproves one’s eligibility for enrollment in the program.

Office of the Inspector General for the Department of Health and Human Services operates Medicaid Fraud Control Units that investigate reported cases of Medicaid fraud. The MFCUs operate in 49 states and the District of Columbia and track down suspected cases of Medicaid abuse. For most states the MFCUs work in conjunction with the states’ attorneys general.

These investigative bodies are funded by both the states in which they operate and the federal government. They have the ability to prosecute alleged violations of Medicaid law but can also refer suspected criminal activity to prosecutors in state and federal judicial offices. The Office of the Inspector General for the Department of Health and Human Services regulates the MFCUs to ensure they are working within their bounds.

Anyone who has faced allegations of committing Medicaid fraud may have found himself dealing with an MFCU. Such allegations can be dealt with at the state level or may balloon up into significant federal charges. While the information contained in this post should not be construed as specific legal advice, individuals seeking more information on Medicaid charges and other federal crimes may choose to speak with attorneys who focus their practices on those specific criminal law fields.

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