Medicaid fraud and abuse costs billions of dollars every year in diverted funds that should have been used for legitimate health care services. Because of the fraud and abuse, the cost of Medicaid is higher, as is the risk of harm to patients who are unwittingly exposed to unnecessary medical procedures. The story of a Kansas City doctor sent to prison for health care fraud reminds us to be vigilant when it comes Medicaid fraud.
Former doctor, Wayne Williamson, imprisoned for the second time
A former Kansas City doctor, 74-year-old Wayne Williamson, has been sentenced to prison for the second time for health care fraud. His latest sentence will last one year and three months in a federal prison. Back in 2010, Williamson was forced to surrender his medical license when he pleaded guilty to fraud and conspiracy to distribute Oxycontin, Percocet, and Xanax, among other related charges. He was sentenced at that time to three years in prison and was permanently banned from participating in Medicare or Medicaid programs.
The second case against Williamson involved working as a consultant for a medical clinic in Independence from 2013 to 2015. In that capacity, he admittedly performed disability examinations as part of a contract with the U.S. Department of Veterans Affairs, despite the fact that he had been excluded from participating in Medicaid and Medicare. In addition to jail time, he was also required to pay restitution in the amount of $39,155.
Medicaid fraud and abuse
Medicaid fraud occurs when someone knowingly misrepresents the truth in order to obtain unauthorized benefits. This type of fraud can be committed by patients as well as health care providers. Medicaid abuse, however, includes any practice that is inconsistent with acceptable economic, business or medical practices and that unnecessarily increase costs. Both types of misconduct violate Medicaid law.
Common examples of health care provider fraud
Some common examples of Medicaid fraud by health care providers include billing for medical services not actually performed, submitting duplicate billing for the same service, submitting a false diagnosis, billing for a more expensive service than was actually performed, receiving kickbacks for referring patients, and billing for covered Medicaid services when a non-covered service was actually provided. Health care provider fraud can also involve ordering excessive or unnecessary tests and prescribing medication that is not medically required, such as narcotics like Oxycontin and Percocet.
Recognizing health care provider fraud
There are several ways to recognize whether provider fraud is occurring with regard to your medical care. For one thing, whenever you obtain health care services, keep a record of the dates you receive those services and save the receipts and statements you obtain from providers. That way, you can compare the dates and services listed in your records with the statements you receive from Medicaid.
Some common examples of patient fraud include filing a claim for Medicaid services or medical products that are not actually received by the recipient, altering or forging receipts in order to receive reimbursement from Medicaid, and obtaining medications or medical equipment that is not actually needed and then selling those items on the black market. Also, providing false information when completing an application for Medicaid services is a violation of Medicaid law. Shopping for doctors so you can obtain several prescriptions for the same medication is also against the law.
In order to avoid unwittingly committing fraud, there are a few things you should not do. First, refrain from contacting your doctor to request a service that you do not really require. Also, never let anyone convince you to see a doctor for medical care or services you don’t need.
How to avoid the appearance of fraudulent transfers
A common misconception that many people share is that they will be required to give away all of their assets in order to qualify for Medicaid if they need long-term care. As a result of this misconception, most people think they can simply transfer their property to their family members in order to protect their eligibility for Medicaid. The issue is that you cannot simply give your property away before you submit your application for Medicaid.
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