Medi-Cal fraud and abuse are an unfortunate reality in our state. Fraud and abuse of these important government benefits cost the country billions of dollars each year, as a result of diverted funds that should have been used for valid medical services. Due to this abuse, the cost of Medi-Cal has continuously increased for many. Fraud and abuse also lead to an unnecessary risk of harm to patients when they are being unnecessarily subjected to medical procedures for the benefit of fraudulent physicians. Here, a Sacramento Medi-Cal planning attorney will explain what Medi-Cal fraud is and how to avoid it.
How does the law define Medi-Cal fraud?
Medi-Cal fraud occurs when someone intentionally misrepresents the truth in order to acquire unauthorized Medi-Cal benefits. As your Sacramento Medi-Cal planning attorney knows, this type of fraud is not only committed by patients, but also by healthcare providers as well.
Some common examples of Medi-Cal fraud committed by patients
Patient fraud can take various different forms. For example, it is considered fraud to submit a claim for services or products that you, as the Medi-Cal patient did not actually receive. Another example is falsifying or altering receipts in order to receive reimbursement from Medi-Cal. Obtaining medication or medical products that are not required for your medical care, and then selling them on the black market, is a more serious type of Medi-Cal fraud. Providing false information, or using someone else’s insurance to obtain medical services you are not entitled to, is also considered fraud.
What you can do to avoid the appearance of Medi-Cal fraud
There are a few things you should avoid doing in order to protect yourself from unknowingly committing fraud. First, do not request a medical service or procedure from your doctor if you do not truly need it. For some, that means refraining from letting others persuade you to seek medical treatment you do not actually need.
So common examples of Medi-Cal fraud by health care providers
What some people may not realize is that Medi-Cal fraud is not only committed by the patient but can be committed by health care service providers, as well. Some common examples of provider fraud include billing for services that were not actually performed or billing duplicate times for the same service. Some health care providers falsify a diagnosis in order to bill for the treatment of that condition. Others bill for more costly procedures than are actually performed.
If a health care provider accepts “kickbacks” for patient referrals, which is also illegal. Billing for a covered service when a service that is not covered was actually performed is another form of fraud. Also, ordering excessive tests that are not needed or prescribing medication that is not actually medically necessary, are both types of Medi-Cal fraud.
Recognizing Medi-Cal fraud committed by health care providers
There also are a few ways you can recognize if your health care provider is engaging in fraud. First, whenever you receive services from your health care providers, keep a record of the dates and save the receipts and billing statements you receive. You can later use them to compare the dates and services on your calendar with the statements you receive from Medi-Cal to determine whether they are accurate.
Avoiding fraudulent transfers in Medi-Cal planning
Another very common type of fraud involving Medi-Cal is attempting to transfer all of your assets into someone else’s name in order to qualify for Medi-Cal benefits. Many times when this happens, people are not even aware that what they are doing is wrong.
That is because there is a common misconception that applying or qualifying Medicaid requires them to give away all of their property. This misunderstanding leads many clients to simply transfer their assets to their relatives in order to protect their eligibility. Unfortunately, this can be a big problem if it seems that you are attempting to hide assets from Medi-Cal in order to qualify.
In short, there is a proper and improper way to do transfers. To avoid problems and possible allegations of Medi-Cal fraud, you should work with an experienced and qualified elder law attorney when contemplating the use of a transfer strategy.
The 5-year look back period
A federal law was passed in 2006 that created a penalty period against anyone who transfers their property within the five years prior to submitting their Medi-Cal application. This law is not yet in effect in California, but will be at some unknown future date. The current “look back” period in California for most transfers is thirty months. Because of both of these laws, the timing of any transfers you make is important because the period of eligibility starts when you submit your application. For that reason, you should work with an experienced and qualified Medi-Cal planning attorney to help with your Medi-Cal planning.
If you have questions regarding Medi-Cal fraud, or any other Medi-Cal planning issues, contact the Northern California Center for Estate Planning and Elder Law for a consultation, either online or by calling us at (916) 437-3500.
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