Fifth Circuit rules overbilling Medicaid is identity theft as well

On Behalf of | Mar 17, 2022 | White Collar Crimes

Technicalities can make a big difference in many criminal cases, and this has been further established by the U.S. Fifth Circuit in a case regarding Medicaid billing. California medical facilities are sales offices, in many ways, and they commonly look for any action or treatment to establish a separate billing entry. One investigation into the practice has resulted in the federal circuit court affirming that the process being filed in the name of patients is actually identity theft as well.

The medical billing process

A typical medical billing case involves two general actions. The first action is the patient allowing the medical professional to submit the financial charge for requested treatment to the government for services payment. Medicaid and Medicare receive these bills on a regular daily basis. In addition to authorizing the submission, the patient agrees to use their actual name in recording the entry. The “use” of the name became the technical issue in this case of white-collar crime.

The technical enhancement

The initial incident was a submission to Medicaid regarding treatment for a service that was never provided. Double-billing is not new to the system, and many medical facility management groups do this when providing multiple types of services, whether intentional or not. The primary statute applied to these cases is a single charge for each instance. However, the law also carries an enhancement of penalties for illegal use of the name as well when a false bill is submitted without separate authorizations from the patient.

The argument of the defendant in this case was that the original authorization for the valid treatment also covered their submission for the falsely billed service. The court refused this assertion, resulting in a potential two-year incarceration addition based on the technicality.