Fraud is something that impacts all most every industry that involves the turnover of large sums of money in large volumes of transactions. One of the most vulnerable institutions for fraud is the medical system, and in particular the Medicaid system. Medicaid fraud not only costs taxpayers millions of dollars every year, but it also impacts the ability of the Medicaid program to help those in need access medical assistance and services. For these reasons it has become necessary for individuals to become their own fraud prevention advocates.

Read Your Statements

Medicaid fraud is not untraceable. There is plenty of evidence to be found if you know what to look for. One of the best tools that you have to prevent Medicaid fraud related to long term care services is your medical care statements.

Each month you will receive a statement which summarizes the long term care services that you received. When you get this statement open it up and read it. What you are going to be looking for are two things. The first thing is charges for things that you did not received, such as tests that you were not given or supplies that were not used for your care. You may be surprised at some of the errors that appear on your bills, such as gynecological services being billed to male patients or treatments for diseases that the patient does not have.

The second thing that you will want to look for is charges that seem too high. For example, a aspirin that costs $20 is a blatant overcharge for basic medications. These overcharges can be caused by computer glitches and type-os, however, they can also be strategically worked into the billing system to bilk extra money from patients that do not read their statements carefully or who do not want to question their health care provider about the services and charges that they incur.

Talk With Your Health Care Provider

Another issue that can be linked to Medicaid fraud is the recommendation of treatments or services that are unnecessary or that are controversial in nature. These recommendations are intended to increase the amount of money that is spent at the hospital without giving the patient some sort of medical benefit. It is a good idea to ask the doctor what each test is for and if it is necessary before agreeing to the test.

Your health care provider can also be a good source of information about what the most cost effective method of treatment for your condition is. While you do not want to sacrifice quality care for cheap care, you do want to do your part to select a treatment that is both effective and not overpriced if possible. For example, you can select a generic drug as opposed to a brand name drug. If a doctor or health care provider is pushing an expensive or controversial treatment without providing a reason for their preference, then you will need to do outside research to see why they are pushing the treatment. Their preference may be solely based on the size of their commission for the treatment or drug.

Fraud comes in many shapes and packages. Sometime errors are going to occur and these can be easily corrected. However, sometimes fraud occurs where a health care provider is consciously taking steps to bilk Medicaid out of money. Both situations cause problems, both need to be corrected and both need to be scrutinized to protect patients and the Medicaid program from abuse.

Conclusion

Medicaid fraud not only impacts the main program of Medicaid, but it can also infect Medigap programs. The best way to identify potential for fraud in the Medigap program will be to evaluate the long term care insurance rate schedules for Medigap polices. Those agents that have extremely high rates for these policies are more likely to be predatory agents than those that offer rates that are appropriate for their market.

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