A dentist who practiced in DeKalb and Gwinnett counties was sentenced to one year and six months in federal prison for Medicaid fraud in April 2017, according to the Atlanta Journal Constitution. She was accused of falsely filing approximately $1 million in Medicaid claims. The U.S. attorney over the case said the dentist submitted bills to the government for procedures she allegedly performed while out of the country.
The dentist, who liked to invest in a variety of real estate holdings, will have to forfeit the dentist office she owned and operated. The federal government alleged she submitted false claims from 2009 to 2013. The claims were for patients she never treated or who were ineligible for Medicaid. The dentist pleaded guilty in November 2016.
What is Medicaid Fraud in Decatur?
In Decatur, Medicaid fraud occurs when a provider intentionally and knowingly causes or makes a claim to the federal government:
- That is false or misleading
- The misleading information is used to obtain reimbursement
- The reimbursement is from the medical assistance program.
- The provider can be anyone providing treatment from a dentist to a doctor, nursing home, or personal care provider.
Types of Medicaid Fraud in Decatur
How a provider obtains money from the government for an allegedly false Medicaid claim varies. It can occur when the provider:
- Phantom bills. Phantom billing happens when a provider submits claims for work he or she never performed.
- Billing for services that were less expensive. For instance, a procedure cost $400. The provider billed Medicaid $1,400 for the procedure.
- Submitting for services separately that can be combined into one claim. This is called unbundling.
- Double billing. Double billing occurs when a provider submits two claims for the same medical service.
- Giving a patient a generic drug, but submitting a claim to the government for a brand name drug.
- Accepting or giving something of value in return for medical services, then submitting a bill to the government.
- Providing a patient with unnecessary services to receive payment from Medicaid.
- Giving the government a false cost report.
Defending Against Medicaid Fraud in Decatur
In the case of Medicaid fraud, defenses vary from lack of evidence to no intent to commit fraud. Lack of evidence occurs when the federal government accuses a provider of Medicaid fraud, but it does not have sufficient evidence to convict.
Federal prosecutors may proceed with the case hoping to get a jury to believe them or a plea deal. A defense attorney will attack their case to show they do not have evidence to convict. Lack of intent defense involves the provider submitting claims with the intent to defraud. The intent may be an error or mistake on the provider’s part.
Contact The Law Firm of Shein & Brandenburg P.C., to Fight Your Medicaid Fraud Charge
Medicaid fraud is a serious charge. To combat the charge, you need a serious defense. Contact The Law Firm of Shein & Brandenburg, P.C. to fight your Medicaid charge.