Being a healthcare provider can offer you a lot of fulfillment while helping people heal. Unfortunately, this profession also comes with many challenges, and dealing with insurance is one of many. If you are being charged with Medicaid fraud, it is imperative that you understand the laws and how charges could affect your career.
The law considers providing the Medicaid program incorrect information as fraud. If you derive financial benefit from the proceeds, the state can charge you with significant penalties. Common types of fraud doctors commit include:
- Changing receipts and bills
- Submitting bills for services that were never rendered
- Submitting bills for ineligible or deceased patients
- Billing for more expensive medication than you gave a patient
- Rebilling patients for services already paid for by Medicaid
- Upcoding a patient’s services
Consequences
In Texas, authorities can charge you for fraud without solid evidence. This is why consulting with an experienced lawyer is important if you intend on continuing your practice. It becomes even more vital if you did not knowingly commit fraud and the charges are brought against you due to a mistake on submitted paperwork.
The Texas Medicaid Fraud Control Unit specifically investigates fraud committed by Medicaid providers. Being charged with Medicaid fraud is a serious crime and may result in you losing your status as a Medicaid provider. You may have to reimburse the state’s losses. You could also face time in jail along with additional fines.
The severity of your charges depends on the degree of financial fraud:
- Class C misdemeanor: Value of the fraudulent claim was less than $100.
- Class B: The value was between $100 and $750.
- Class A: The value was between $750 and $2,500.
- State jail felony: The value was between $2,500 and $30,000, or it cannot be reasonably ascertained.
- Third degree felony: The value was between $30,000 and $150,000, or you submitted between 25 and 50 fraudulent claims.
- Second degree felony: The value was between $150,000 and $300,000, or you submitted more than 50 fraudulent claims.
- First degree felony: The value was more than $300,000.
The fines and jail time associated with your crime ultimately depend on your trial’s outcome. Consulting with a lawyer is beneficial for protecting your career’s future.
