New York patients are protected against unethical doctors and medical facilities. Through these laws, they are protected against doctors that attempt to collect large sums of money through insurance fraud. Among the most common types of insurance fraud are attempts to file for services that weren’t performed. A Medicaid Fraud Lawyer Orange County NY can help low-income families avoid these issues quickly.
Filing False Claims
Doctors commit insurance fraud by filing claims for services that weren’t performed. Since most Medicaid recipients don’t receive invoices for all services they receive the doctors could file without their knowledge. However, the insurance provider may apply restrictions on how often these patients may receive select services. If they don’t possess a medical condition that warrants an excess of a specific service, it sends up a red flag with the insurer.
Over-billing Patients for Services
Select doctors charge co-pays for Medicaid patients. However, Medicaid pays the full cost of most services. When doctors increase the price of services, this could leave the patients with an excess charge. Medicaid workers review these claims to determine the average cost of these services among primary care physicians. Any Medicaid patients who receive excessive bills for services should report them to their caseworker.
Performing Unnecessary Services
Doctors who provide services to Medicaid patients may perform expensive services that aren’t necessary medically. For example, a common reason that a small child could have a high fever is an ear infection. If the doctor performs a spinal tap on the child, they have performed an unnecessary service if an ear exam could’ve identified the condition sooner.
Medicaid reviews claims and the diagnosis provided by the doctor. When doctors perform unnecessary services, they file a claim through Medicaid to collect higher profits. If the procedure is unnecessary medically, the caseworker could identify a case of fraud. This will lead to a legal claim against the doctor.
New York patients must report any odd billing patterns or excessive charges from their doctor. Patients who receive Medicaid as an insurance provider could fall victim to fraud most often. Patients who suspect unethical practices should hire a Medicaid Fraud Lawyer Orange County NY by contacting Mark Aberasturi today.
