Five Common Questions Answered About Medi-Cal Fraud

ken-treloar-385255-copy-300x200Medi-Cal fraud occurs more frequently than you think and often goes unnoticed. Unfortunately, this only harms recipients and future recipients of Medi-Cal who desperately need this healthcare assistance program in order to obtain the medical treatments they require. As a whistleblower, you have the opportunity to help put an end to Medi-Cal fraud by reporting healthcare providers and professionals who engage in fraudulent acts. If you detect any fraudulent acts by your healthcare provider, contact the healthcare fraud attorneys at Willoughby Brod today to learn more about how you should proceed with your whistleblower claim.

What is Medi-Cal?

Medi-Cal is a California Medicaid program for low income adults and children that is supported by both federal and state taxes. Those who qualify for Medi-Cal can receive free or low-cost healthcare services and generally receive the same benefits offered under Covered California but at much discounted or free prices. Anyone can apply for Medi-Cal regardless of age, sex, race, religion, sexual orientation, color, national origin, marital status, disability, or veteran status.

What is Medi-Cal Fraud?

Medi-Cal fraud can be committed by individuals and institutions alike. Individuals may attempt to lie about their eligibility, and institutions may attempt to submit false billings and charges.

How do Individuals Commit Medi-Cal Fraud?

Individuals can commit Medi-Cal fraud by lying about their eligibility or lying about someone else’s eligibility. Typically, were it not for the lie, the individual in question would not have received Medi-Cal benefits.

How Do Medical Professionals and Institutions Commit Medi-Cal Fraud?

Medical professionals and providers can also commit Medi-Cal fraud, and if you notice your healthcare employer or provider committing Medi-Cal fraud, contact an experienced whistleblower attorney immediately to learn more about how you can report the fraud and potentially receive compensation for your tip. Below are a few of the most common ways in which healthcare professionals and providers may commit Medi-Cal fraud:

  • By presenting false claims for payment under Medi-Cal,
  • By knowingly presenting false information regarding the services administered under Medi-Cal in order to obtain more payment for the services provided,
  • By knowingly presenting false information in order to obtain authorization to perform services for Medi-Cal patients, or
  • By knowingly engaging in a fraudulent scheme or using false pretenses to obtain Medi-Cal money or property related to healthcare services performed.

In some cases, the healthcare fraud may have started as an honest mistake. For example, a healthcare professional may have accidentally undercharged a Medi-Cal patient for the services received and later attempt to make up the undercharge with an overcharge on a future bill. Even though this act started as an honest mistake, it turned into fraud when the patient’s future bill included an intentional overcharge.

What are the Penalties for Committing Medi-Cal Fraud?

Medi-Cal fraud is considered a crime and can be charged as either a misdemeanor or a felony, depending on the offending party’s criminal history and extent of the fraud committed. A misdemeanor charge can result in probation, a fine of up to $150,000 or twice the amount of the fraud (whichever is greater), and up to one year in county jail. A felony charge can result in the penalties given in a misdemeanor charge, plus reimbursement to the insurer, sentencing under California’s Realignment Program, and county jail time of up to five years.

Now that you are more familiar with the many forms that Medi-Cal fraud takes in your daily life, you have the opportunity to detect Medi-Cal fraud when you see it and help put an end to Medi-Cal fraud. The whistleblower attorneys at Willoughby Brod have helped numerous healthcare whistleblowers report fraudulent Medi-Cal practices and help put an end to this crime. If you suspect that your healthcare employer or provider is committing Medi-Cal fraud, contact us at (800) 427-7020 or visit us online to schedule your free consultation today.

(image courtesy of Ken Treloar)