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What constitutes Colorodo Medicaid fraud?

On Behalf of | Oct 8, 2021 | Criminal Defense |

Billions of dollars in Medicaid funding are paid annually to individuals in Colorado requiring financial assistance. For these adults and children who need financial help to cover the cost of medical equipment and health services, receiving this money is critical. However, some providers attempt to steal from the Colorado Medicaid system by claiming more payments or benefits than they are entitled to receive. Understanding more about this white-collar crime may help individuals accused of it understand their criminal charges.

Examples of Medicare fraud schemes

Providers who attempt taking money from the Colorado Medicaid system fraudulently might use several schemes to get paid more than is due. Billing for office visits that never occur or billing for more time than was spent with the patient are two ways providers try to get money out of the system.

Calling a patient to have them book another appointment when it’s not required and billing them for a visit is another method that providers might rely on to gain more income. Providers may also order unnecessary services and bill for drugs or medical equipment and supplies that are never given to a patient.

How Medicaid fraud is spotted

One way that patients and officials spot Medicaid fraud is by carefully reading the Explanation of Benefits information provided by Medicaid. Noticing incorrect information different from the services received is a red flag that often gets reported to the Medicaid office listed on the form. Patients sometimes call the state’s Attorney General’s Medicaid Fraud Control Unit for someone to investigate the situation.

Those who are accused of Medicaid fraud are not always guilty of trying to cheat the system; sometimes, simple mistakes are made. Individuals who are facing charges for white-collar crime will need to show evidence that they were attempting to follow proper policies if they want to avoid a conviction.