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Thelawman2, Lawyer
Category: Criminal Law
Satisfied Customers: 1029
Experience:  Attorney-at-Law
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What constitutes Medicaid fraud in Ohio? Who can be charged?

Customer Question

What constitutes Medicaid fraud in Ohio? Who can be charged? Specifically, my son has been receiving services such as a private nurse to watch him up to 40 hours a week (via a Medicaid contracted agency) in my home and I havent updated my financial information (currently have a substantially higher income now than when he started receiving assistance and that I currently hold private health insurance for him. Additionally,I pay the nurse on the side to babysit my other two children at the same time she is caring for my son who is receiving Medicaid benefits. Does this constitue Medicaid fraud?
Thank you for your advice.
Submitted: 3 years ago.
Category: Criminal Law
Expert:  Thelawman2 replied 3 years ago.

Thelawman2 :

It would be considered Medicaid fraud to under-report your income in order to obtain medicaid. Therefore, it could be considered Medicaid fraud if your son's access to medicaid funds is based on the salary that you are reporting

Thelawman2 :

You should hire a local attorney to help you correct this under-reporting and have them explain, if the issue comes up, that it was an oversight.

JACUSTOMER-vu3b0x71- : Thank you for that response. What about the other components in my question. Could you please address them?
Thelawman2 :

Paying the nurse on the side to babysit your other children would not be medicaid fraud as long as she is not billing to Medicaid any services that she provides to your other children.

Thelawman2 :

And you can have both private insurance and Medicaid. If you have private health insurance available to you or a member of your family, eligibility for Medicaid will not be affected. Any service not covered or only partially covered by a private health insurance plan and listed as a Medicaid covered service will be paid by Medicaid. Medicaid will pay up to the maximum Medicaid is allowed to pay

Thelawman2 :

Whenever you have both private health insurance and Medicaid, you should show both your Medicaid card and your health insurance card to your medical provider each time you receive services.

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