What are the Elements of Medicaid Fraud?
Knowingly make or cause to be made, false or misleading statements in a Medicaid program application, or in a document that requires a disclosure of assets to determine Medicaid eligibility.
Knowingly conceal an interest in property in a Medicaid program application, or in a document that requires a disclosure of assets to determine Medicaid eligibility.
Knowingly fail to disclose a transfer of property that occurred in the 36 months prior to submitting a Medicaid application or document in a Medicaid program application, or in a document that requires a disclosure of assets to determine Medicaid eligibility.
Knowingly fail to disclose a transfer of property that occurred in the 60 months prior to submitting a Medicaid application or document that was made to an irrevocable trust
A portion of which is not distributable to the applicant for or the recipient of Medicaid or to a revocable trust.
What Are Potential Sentencing and Fines?
If the value of the Medicaid paid as a result of the fraud is less than $1,000, the violation is a 1st degree misdemeanor with up to 6 months in jail and a fine of up to $1,000.
If the value of the Medicaid paid as a result of the fraud is between $1,000 and $7,500, the violation is a 5th degree felony with 6 – 12 months in jail and a fine of up to $2,500.
If the value of the Medicaid paid as a result of the fraud is between $7, 500 and $150,000, the violation is a 4th degree felony with 6 – 18 months in prison and a fine of up to $5,000.
If the value of the Medicaid paid as a result of the fraud is greater than $150,000, the violation is a 3rd degree felony with 9 – 36 months in prison and a fine of up to $10,000.
Additionally, the court shall order restitution in the amount of Medicaid paid plus interest.
Question: If I receive and keep Medicaid benefits that I should not have received, am I guilty of Medicaid eligibility fraud?
Answer: If you provided full asset disclosure to determine Medicaid eligibility benefits, and you mistakenly received benefits that you were not entitled to, you have not committed Medicaid eligibility fraud. Full asset disclosure is a valid defense to a Medicaid eligibility fraud charge.
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