Most Medicaid fraud is committed by providers rather than patients. Providers, such as doctors, clinics, hospitals, and pharmacies, have more significant opportunities to manipulate billing processes and claims submissions to commit fraud. Common provider-related fraud includes:
Comments
2. Upcoding: Billing for more expensive services than those actually provided.
3. Unbundling: Billing separately for services that should be combined, leading to higher
Patients can commit Medicaid fraud in various ways, including:
1. False Enrollment: Falsifying information about income,residency, or family status to qualify for Medicaid benefits when they are not actually eligibl
3. Selling Medicaid Benefits:Selling or lending Medicaid identification to another person,allowing access tounauthorized healthcare services.
5. Prescription Fraud: Altering prescriptions or using another person’s Medicaid information to fill prescriptions fraudulently.