Frank A. Rubino , ESQ.

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Medicaid Fraud Cases Big Money for Florida Government

State officials released the results of the 2011 fiscal year recently. In total, the state is claiming it recovered $142 million in Medicaid fraud actions. That number comes from a report filed by the Florida Attorney General's Office and the Florida Agency for Health Care Administration. The time and resources used to investigate and prosecute Medicaid fraud cases has grown in recent years. The increased emphasis comes as the government looks to justify the increasing budget dedicated to Medicare and Medicaid.

The Medicaid Fraud Control Unit conducted more than 350 investigations last year, leading to 60 cases going to prosecutors. The targets of these prosecutions include a wide range of health care participants, such as doctors, drug companies, home health care providers, durable medical equipment providers, pharmacies and more. Whether a company or an individual is targeted, they face an aggressive foe with nearly unlimited resources.

The $142 million figure does not include that state's efforts to prevent improper Medicaid spending or its efforts to shift liability for medical treatment from Medicaid to another party. Even if no fraud occurs, almost any individual or entity involved in billing for Medicaid services could draw the scrutiny of government officials. As Florida attempts to reduce the number of people who rely on Medicaid for services, officials take a close look at what spending is appropriate and where fraud and misuse of funding occurs.

The state is proud of the depth and breadth of its efforts to curtail Medicaid fraud. Given the massive funds used to investigate and prosecute the crime, anyone suspected of Medicaid fraud should understand by now the trouble they are in. A billing or accounting mistake could leave you facing stiff criminal and civil penalties.

Source: South Florida Business Journal, "Florida recovered $142M in Medicaid fraud cases in 2011," by Brian Bandell, 24 January 2012

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