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Protecting Your Illinois Medical Practice Against Medicaid Fraud

Posted on in Healthcare License Defense IDFPR

shutterstock_1499270159-min.jpgOne of the most stressful – and potentially devastating – thing that can happen to a medical provider is to be accused of Medicaid fraud. The consequences can result in actions taken against your medical license, being required to pay back the alleged fraudulent funds, and being barred from any future Medicaid billing. In some cases, it can even result in criminal charges. Even if you are not engaged in fraud, someone in your practice could be. It is important for every provider to know what the signs are that potential fraud could be taking place.

Billing “Errors”

Medicaid and insurance billing are complex, and errors can happen. But when someone is actively involved in Medicaid fraud, they often are billing for services that patients never received, or they could be submitting duplicate bills for a single treatment or service.

Unnecessary Treatments

If you suspect another provider in your practice is providing expensive, unnecessary treatments, Medicaid considers this overtreatment. The government also considers this a type of Medicaid fraud.


There are federal laws in place that prohibit the activity of “kickbacks.’ Kickbacks are when a medical facility solicits referrals from out-of-network providers. A provider receives some kind of financial gain from the facility for every patient referral they give.

How Can You Prevent Fraud in Your Practice?

There are steps that every medical provider can take to help protect from others committing Medicaid fraud in their facility. One of the most critical steps you can take is to run thorough background checks on every new employee your practice hires. Not only will these background checks help identify potential issues with new hires, but they can also help keep insurance premiums lower.

Another key step is to assign different tasks to different employees. The inputting of patient record data, generation of insurance invoices, and receipt of payments should each be performed by different employees. No one employee should be responsible for all three of these duties.

It is not uncommon in larger practices for managing partners to let other people address deposits and payments. However, one strong barrier against Medicaid fraud is to require that all deposit and payment records made should contain managing partner signatures.

Contact a Cook County Professional License Defense Lawyer

If you are being investigated for Medicaid fraud, do not delay in contacting a Chicago, IL medical license defense attorney. Call Williams & Nickl, LLC at 312-335-9470 to schedule a free and confidential consultation to find out what legal options you may have.


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