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Case shows need to review billing dates before submitting claim to Medicaid

On Behalf of | Feb 24, 2022 | False Claims |

Filling out paperwork is often a tedious, time-consuming process. This is true on both sides of the healthcare system — neither patients nor hospitals or physicians are likely to find joy in filling out the paperwork required by insurance providers. But a failure to do so accurately can result in serious repercussions.

Take a recent case involving an optician as an example. In this case, the feds chose to open an investigation on the optician who claimed to provide eyeglass fittings for nursing home residents. The problem, according to the feds, is that the patients he billed Medicaid for were deceased at the time of the billing. During the investigation the prosecution was able to gather enough evidence to support their allegation that this was more than just a clerical error. When faced with the evidence, the optician chose to accept a guilty plea and will serve 90 days n jail as well as an additional five years on probation and a restitution payment of $74,000 instead of fighting the government’s claims.

Although the feds argue this case was a prime example of healthcare fraud, it provides valuable lessons to anyone billing Medicare, Medicaid, or another insurance provider. Namely:

  • Make sure paperwork is accurate. A typo for the date or other portion of the form could lead to allegations of healthcare fraud.
  • Keep good records. Part of the government’s allegations included the claim the optician had not provided care to billed patients. Without records of these meetings those who face allegations have a difficult time maintaining their innocence.

Attorney John Rivas is responsible for this communication

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