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How Doctors Commit Medicaid Fraud

On Behalf of | Jan 27, 2021 | Fraud, White Collar Crimes

Medicaid fraud in Ohio costs the state millions of dollars each year. This type of fraud is hurtful because it diverts funds from people who could benefit from legitimate health care services. Governments at all levels are taking steps to stop individuals who wish to defraud the Medicaid process.

Medicaid fraud defined

Medicaid fraud is a white-collar crime committed by a physician when an attempt is made to conceal or misrepresent information to gain payments from the Medicaid system. One way doctors become guilty of Medicaid fraud is by billing the system for services they never provided. Other examples of Medicaid fraud include:

  • Billing for unnecessary services
  • Billing for an expensive procedure when delivering a less expensive service
  • Billing multiple times for a single service
  • Billing individual steps of a procedure as a separate service
  • Accepting kickbacks
  • Prescribing unnecessary medication

Medicaid fraud prosecutions

The investigation and prosecution of Medicaid fraud in Ohio is the responsibility of the Attorney General’s Office. The AG’s office employs a team of legal professionals whose job centers around protecting the integrity of the Medicaid program in the state. The filings for Medicaid fraud cases in Ohio happen in Franklin County regardless of where the crime took place.

Penalties for Medicaid Fraud

The severity of a Medicaid fraud conviction can vary greatly depending on the value of the goods and services involved with the fraud. The minimum charges include a first-degree misdemeanor that can result in six months in jail and a $1,000 fine. On the other end of the scale, Medicaid fraud involving more than $150,000 value can result in as much as five years imprisonment and a fine of $10,000.

Medical professionals accused of Medicaid fraud are likely unfamiliar with the legal process. But these doctors will need to mount a vigorous defense to protect themselves from the damage such allegations can do to their lives and careers. Physicians facing Medicaid fraud charges may provide themselves with a better chance for a favorable outcome by speaking with an attorney.


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