Medicaid Fraud

Sec. 35A.01. MEDICAID FRAUD

Medicaid Fraud is very complicated and can often be a difficult case for the State to Prove Beyond a Reasonable Doubt. The following provides some brief explanation as to what constitutes Medicaid Fraud, however the statute includes much more that the synopsis below.

The following include some of the more common types of Medicaid Fraud:

A person can be charged with Medicaid Fraud if s/he permits a person to receive a benefit or payment under the Medicaid program that is not authorized or that is greater than the benefit or payment that is authorized through the following means:

  • knowingly makes or causes to be made a false statement or misrepresentation of a material fact
  • knowingly conceals or fails to disclose information that permits a person to receive a benefit or payment under the Medicaid program that is not authorized or that is greater than the benefit or payment that is authorized;

A person may also be charged if s/he knowingly applies for and receives a benefit or payment on behalf of another person under the Medicaid program and converts any part of the benefit or payment to a use other than for the benefit of the person on whose behalf it was received;

An employee/agent may also be charged if s/he knowingly makes, causes to be made, induces, or seeks to induce the making of a false statement or misrepresentation of material fact concerning the conditions or operation of a facility in order that the facility may qualify for certification or re-certification required by the Medicaid program or provided this information when it is required to be provided by a federal or state law, rule, regulation, or provider agreement pertaining to the Medicaid program.

Range of Punishment for this offense is between a Class B Misdemeanor to a 1st Degree Felony depending on the value of the diverted or used service (an aggregate amount can be used if the violation was as a result of a scheme or a continuing course of conduct) and/or if the person has previously been convicted for the same offense.

Gilbert G. Garcia, has practiced Criminal Law since 1978 and has been Board Certified in Criminal Law since 1989. The Gilbert G. Garcia Law Firm is the logical choice to represent you in your criminal case, providing the quality legal services you deserve in your most important matters.

Free initial consultations and reasonable fees. Personal payments plans available and most major credit cards accepted. Many issues are able to be handled via e-mail, phone calls and fax and after hours and weekend appointments are available upon request to meet the needs of each client.

Conveniently located on the Montgomery County Courthouse square since 1983.

For more information on Contact Gilbert Garcia today at 936-756-3333  
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