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Pharmacy Medicaid Fraud Lawyer Update

Our Whistleblower lawyers are often asked to comment about Medicaid Fraud, which has been said to be the second largest white collar fraud in the United States. If you are aware of any fraudulent activity it is important for you to speak out – healthcare fraud affects all Americans and our tax dollars. It has been said that hundreds of millions of dollars in fraud occur on a regular basis. Recently, the owner of a pharmacy in Brooklyn was arrested for billing Medicaid for prescriptions that were never filled. While the owner denies any wrongdoing, it is currently being investigated. Not only is reporting fraud the right thing to do, you could be eligible for a reward. Contact our office to learn more about your options under state and federal law.

Below are some examples of Medicaid Fraud are:

1. “Phantom billing.” Phantom billing is the practice of billing for medical services not actually performed.

2. “Upcoding.” Upcoding is the practice of billing for a more expensive service than the service that was actually provided to the patient.

3. “Unbundling.” Unbundling is the practice of billing for several services that should be combined into one billing.

4. “Duplicate billing.” Duplicate billing is the practice of billing twice for the same medical service.

5. “Kickbacks.” A Kickback is the practice of giving or accepting gifts in return for medical services.

6. Dispensing generic drugs and billing for name brand drugs thereby obtaining an unfair profit.

7. “Providing unnecessary services.” Providing unnecessary services can include treating a patient beyond the time necessary to achieve the patient’s maximum health benefit.

Under the False Claims Act, a healthcare provider is liable if he or she knowingly files a false or fraudulent claim for payment or approval to Medicare or any other governmental healthcare program or knowingly makes, uses, or causes to be made or used, a false record or statement to get a false or fraudulent claim paid or approved by a healthcare program. If an individual or company is found to be guilty, the government may recover “treble damages” (that is, triple damages) as well as impose monetary penalties ranging from $5,500 to $11,000 per violation. Medicare and Medicaid fraud are serious and costly violations of federal law which can also result in exclusion from participating in Medicare and Medicaid. Doctors and companies who commit Medicaid fraud are stealing money from the public. These actions unfairly drain valuable public resources. Every time someone commits Medicaid fraud, they are stealing money that could be used for purchasing new school books, fixing our bridges, or caring for our elderly. In the end, their dishonesty is raising taxes and putting their needs ahead of their patient care and public good. You can help put an end to this and blow the whistle. Call our office and learn your options.


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