• Medicaid fraud can be undertaken by both doctors and patients.doctor visiting image by TEMISTOCLE LUCARELLI from Fotolia.com
  
  Medicaid is a program designed to provide individuals who cannot afford needed health care with the care that they need. The costs for this care are shared between federal and state agencies so that neither has to pay the full cost of the medical treatment. Medicaid fraud costs taxpayers millions of dollars each year and may be performed by doctors (provider fraud) or Medicaid recipients (recipient fraud).
  
  

Provider Fraud - Phantom Billing

• One of the most common types of Medicaid fraud by medical providers is known as "phantom billing." Tests and other procedures are billed to Medicaid which were never performed, resulting in a payout which the doctor can keep for himself.
  
  

Provider Fraud - Bill Padding

• Another common type of provider fraud is bill padding. With bill padding, the doctor charges for procedures and tests that are rendered but are not necessary. This results in the Medicaid recipient having to undergo a variety of tests or other medical procedures which aren't used in their diagnosis or treatment so that the doctor can receive a larger payment. Some providers even pad the bill by billing twice for the same services.
  
  

Provider Fraud - Prescription Switching

• Prescription switching occurs when a patient is given a generic medication and Medicaid is then billed for a brand-name prescription. This form of provider fraud is not as common as some other types of fraud due to the fact that it requires a prescription to be written and can only be done by a pharmacist or other medical dispensary. The doctor who wrote the prescription may not be aware that it has been switched for a generic medication.
  
  

Recipient Fraud - Incorrect Reporting

• Medicaid recipients must report all of their income when applying for Medicaid. Individuals who make enough money to afford medical insurance or who can pay for their own medical care are likely to be denied Medicaid when they apply. By withholding information about their income they can make themselves appear to have fewer assets, resulting in their receiving Medicaid when they do not actually qualify for it.
  
  

Recipient Fraud - Insurance Fraud

• Medicaid recipients must inform their Medicaid office of any private insurance they have, and must update their status with the office if they acquire private insurance while receiving Medicaid benefits. By failing to report private insurance, individuals who would not be eligible for Medicaid coverage due to having their own insurance can receive Medicaid and use it to cover out-of-pocket expenses.
  
  

Recipient Fraud - Unauthorized Use

• A Medicaid card is intended to be used only be the Medicaid recipient that it has been issued to. Some Medicaid recipients allow friends or family members to use their Medicaid cards when seeing a doctor, effectively sharing their coverage. This allows individuals who don't have Medicaid to still reap the benefits of Medicaid coverage, saving themselves the cost of medical treatment, prescription drugs, and private insurance.