Tampering With Records Medicaid Fraud

How can "Tampering with records" get a healthcare in trouble for Medicaid fraud?

"Tampering with records" can lead to serious legal consequences for healthcare providers and is a common issue in Medicaid fraud cases. Here's how it can get a healthcare provider in trouble:

1. Submission of False Claims

• Medicaid requires accurate records to support claims for reimbursement. If a provider alters or falsifies patient records, billing records, or other supporting documents to obtain payments they are not entitled to, this is considered fraud.
• Example: A provider inflates the number of services rendered or changes diagnostic codes to bill for more expensive procedures.

2. Obstruction of Investigations

• Tampering with records during an investigation, such as altering or destroying documents requested by Medicaid auditors, can be seen as an attempt to obstruct justice.
• This behavior raises red flags and could lead to criminal charges beyond Medicaid fraud, including charges for obstruction of justice.

3. Patient Harm or Misrepresentation

• Altering patient medical records can lead to improper treatments or misdiagnoses, which not only endanger patients but also violate Medicaid regulations.
• Example: A healthcare provider changes patient records to justify medically unnecessary procedures for profit.

4. Violation of Federal and State Laws

• Medicaid is funded jointly by state and federal governments, and tampering with records violates laws such as:
  • False Claims Act: Filing claims based on falsified records constitutes a false claim.
  • HIPAA: Tampering with records may involve breaches of patient privacy.
  • State Medicaid Fraud Control Unit (MFCU) Laws: States have specific laws against falsifying Medicaid-related documentation.

5. Audits and Red Flags

• Medicaid programs regularly audit providers. If inconsistencies or signs of tampering are detected, it triggers a deeper investigation. Providers may face penalties such as fines, suspension from the Medicaid program, or criminal charges.

When to Consult an Attorney:

• If contacted by Medicaid fraud investigators.
• Upon discovering irregularities in documentation.
• When facing accusations of tampering with records or other fraud-related offenses.

Early legal counsel can mitigate risks and ensure compliance with legal and regulatory standards.

Sallynda Rothchild Dennison has decades of experience fighting charges of Medicaid Fraud. Contact Sallynda as soon as possible if you have been contacted about Medicaid fraud or have reason to suspect that an irregularity has occurred.

This blog should not be construed as legal advice, it is an advertisement. Contact attorney Sallynda Rothchild Dennison for actual and discreet legal advice that takes into account your details, State, and circumstances, among other things.