NJ Medicaid Penalties You Need to Be Aware Of

Medicaid is health insurance that the government offers to people who may have low income or certain health conditions. This means it’s paid for with public funds that are collected through income taxes. Eligibility can vary by income, household size, and citizenship status, depending on your state. While Medicaid is a great option for many there are some penalties you should be aware of. 

The Medicaid Look-Back Period and transfer penalties

The Medicaid look-back period and transfer family rules is a scary thing for most applicants applying for Medicaid. There is a question on the Medicaid application that asks whether you have given away or transferred any assets for less than fair market value within five years before the application. The five years before the form is called the look-back period. If you answered yes to this question on the application, then you won’t face what’s known as a transfer penalty unless you have resolved it before you apply. A Transfer penalty is a temporary delay in eligibility starting from the time of application how long that delay depends on which state you’re in.

Medicaid fraud penalties

Medicaid fraud happens when a health provider misrepresents the services rendered and thereby increases the reimbursement from Medicaid. A provider can be any individual or company that provides services to Medicaid participants.

Examples of Medicaid fraud?

  • Phantom billing: Billing for any services not performed, 
  • Upcoding: Billing for a more expensive service than was rendered
  • Unbundling: Billing for several services that should be combined into one billing
  • Billing twice for the same medical service;
  • Dispensing generic drugs and billing for brand-name drugs;
  • Giving or accepting something in return for medical services, known as a kickback;
  • Bribery;
  • Billing for unnecessary services;
  • Submitting false cost reports; and
  • Falsifying timesheets or signatures in connection with the provision of personal care or consumer-directed home health services.

The legal consequences for this type of fraud conviction can vary depending upon the circumstances of each case but are generally very strict. A person convicted can face up to five years in prison per count, even for a first-time offense. A company or corporation that is convicted of felony Medicare or Medicaid fraud can be fined up to five hundred thousand dollars per count. A misdemeanor conviction can bring up to two hundred and fifty thousand dollars for a corporation, and a person found guilty of misdemeanor Medicare fraud can face a fine up to one hundred thousand dollars. 

Law attorney New Jersey can help with Medicaid legal services

SCC legal will provide you with the highest quality legal expertise and guidance you need from Frank R. Campisano. In addition to Medicaid legal services, we can also prepare additional estate planning documents, such as your Last Will and Testament, Health Care Proxy/Medical Directive, Power of Attorney documents and trusts. For more compassionate legal guidance and a free consultation, please contact us or visit our website at https://www.scclegal.com/

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