Health insurance Fraud: Insurance fraud happens when any act is committed with the criminal intent to fraudulently obtain some benefit to which a person is not entitled. It also happens when someone willfully denies some benefit that is due and to which an individual is entitled.
Medic aid providers include doctors, dentists, hospitals, nursing homes, pharmacies, clinics, counselors, personal care/homemaker chore companies, and any other individual or company that is paid by the Medicaid program. If a provider intentionally misrepresents the services rendered, and therefore increases their reimbursement from Medicaid, Medicaid fraud has occurred.
Medicaid fraud includes …
Billing for medical services not actually performed, known as phantom billing
Billing for a more expensive service than was actually rendered, known as up coding
Billing for several services that should be combined into one billing, known as unbundling
Billing twice for the same medical service
Dispensing generic drugs and billing for brand-name drugs
Giving or accepting something in return for medical services, known as a kickback