Medicaid is a federal and state partnership that provides more than $27 billion in health care services to 4 million Florida residents. Medicaid dental fraud is committed when a dental service provider, with or without a patient’s knowledge, submits fraudulent billing for reimbursement by the state.
The most common forms of Medicaid dental fraud involve billing for services and/or tests that were never performed, overbilling for services, or billing for medically unnecessary procedures. In 2017-2018, Medicaid fraud recoveries by the State of Florida totaled $61.5 million.
Fraud can be accomplished in many ways. Here are just a few:
- Unqualified service provider: Billing will be fraudulent if the services are performed by an unlicensed or unqualified provider, or a provider whose Medicaid privileges were terminated for improper behavior.
- Biller impossible days: When adding up the billing for each day, the provider is offering services in excess of 24 hours.
- Recipient impossible days: Services are allegedly provided to a patient who was unavailable or perhaps not even alive that day.
- Biller excessive days: When adding up the billing for each day, the provider is offering services in excess of 10 hours a day.
- Medicaid Fraud Complaints: Patients and their families, health care providers and their staffs, and investigators can all initiate Medicaid dental fraud complaints. Under Florida law, people who file Medicaid fraud complaints might be eligible for cash rewards. In 2017-2018, over $200,000 was paid out to these complainants. Medicaid dental fraud can also be discovered through data mining to look for patterns of billing abuses by individual or corporate providers.
Complaints are investigated by the Florida Medicaid Fraud Control Unit. Each complaint is reviewed within 30 days to determine whether there is a basis for further investigation.
The State of Florida can file criminal and civil proceedings against an offending provider requesting criminal penalties, recoupment of overpayments, and fines. This means possible prison time and financial ruin. If a Medicaid fraud complaint is opened against you, you should immediately seek legal counsel.
Talk to a skilled Medicaid fraud defense lawyer
You have the right to legal counsel during all phases of a Medicaid fraud investigation. Don’t forgo that right. Call (305) 403-7323 or reach out to Florida Medicaid fraud defense attorney Nayib Hassan online to discuss your case and your needs.