Is Your Employer Guilty of Providing False Documentation to Medicaid?
State False Claims Acts are violated when a Medical provider (dentist, physician, mental health provider) or Medical facility (hospital, clinic, pharmacy, nursing home, home care agency, medical transportation company, durable medical equipment company, pharmaceutical company) submits a claim to Medicaid using altered cost reports, falsified medical records, billing scams, or maintains incomplete records.
Common False Documentation Practices that Violate Medicaid False Claims Laws
If you have information regarding a violation of the False Claims Act through false or incomplete documentation practices, you may be entitled to a large cash award for reporting fraud. Typical issues regarding false documentation that Medical providers use to defraud state Medicaid programs include:
- Misrepresenting diagnoses or symptoms: Recording non-existent or exaggerated patient symptoms or diagnosis in order to bill Medicaid for treatments, laboratory work, diagnostic tests, x-rays, medical devices or pharmaceuticals.
- Altering dates or times: Altering dates or times on medical records to fit within an eligible Medicaid coverage period.
- Billing schemes: Billing Medicaid for products or services not provided, upcoding, unbundling, double billing or submitting claims for ineligible patients.
- Incomplete record maintenance: Neglecting to utilize proper medical documentation, recordkeeper initials, dates, times, or details regarding Medicaid beneficiary health.
- Unauthorized signature: Signing prescription forms or other regulated documents by unlicensed nurses or staff.
State False Claims Acts have a whistleblower provision calling for cash rewards of 15 to 30 percent of the money the state recovers for tipsters who were the first to report the fraud with insider information that helps make a Medicaid fraud case. State False Claims Acts also protect tipsters who blow the whistle, making it illegal to fire or harass an employee who reports fraud.