According to a recent article, a physician assistant employed at a medical clinic in Fountain Valley was convicted of federal drug-trafficking after it was discovered that the health care provider was writing prescriptions for narcotics without a medical purpose.
Specifically, Kaitlyn Phuong Nguyen was found guilty of illegally distributing oxycodone, methadone, and alprazolam through prescriptions with no medical need. According to the prosecutors in the case, Nguyen “performed only cursory examinations” on patients before writing prescriptions for addictive drugs. Nguyen could be sentenced to a maximum of 140 years in federal prison.
Doctor running the clinic also found guilty
Dr. Victor Boon Huat Siew of Laguna Beach, the doctor running the Fountain Valley clinic, was sentenced to close to six years in prison. He pleaded guilty to two counts of illegal distribution of a controlled substance. The doctor actually admitted to illegally prescribing the same controlled substances as his assistance from 2009 through 2015.
Based on the evidence, these two health care providers issued prescriptions for the narcotics for patients without a medical need in exchange for cash and insurance payments. They did so, ignoring the clear indications that these individuals were abusing the drugs. There was also evidence that at least four people had died of drug overdoses as a result of receiving prescriptions from Nguyen.
Understanding Medi-Cal fraud
Unfortunately, Medicaid fraud and abuse is a reality. It costs billions every year in diverted funds that could have been used for valid health care services. Because of this fraud and abuse, the cost of Medicaid has increased needlessly. Another problem is the risk of harm to patients who are unknowingly exposed to unnecessary medical procedures for the benefit of fraudulent doctors. Your Medi-Cal attorney can help you avoid fraud on your part.
Medicaid fraud happens when someone intentionally misrepresents the truth in order to acquire unauthorized Medicaid benefits. Medicaid fraud is not only committed by patients. Healthcare providers can be guilty of Medicaid fraud, as well.
Common examples of health care provider fraud
Medicaid fraud is not limited to the actions of the patient, but can also be committed by health care service providers. Here are some common examples of that type of Medicaid fraud:
- Billing for services not actually performed
- Billing duplicate times for the same service
- Falsifying a diagnosis
- Billing for a more costly service than performed
- Accepting kickbacks for patient referrals
- Billing for a covered service when a non-covered service was provided
- Ordering excessive or inappropriate tests
- Prescribing medication that is not medically necessary
There are a few ways you can recognize this type of fraud. When you receive services from your health care providers, keep a record of the dates and save the receipts and statements you receive. You can then compare the dates and services on your calendar with the statements you receive from Medicare to make sure they are accurate.
Typical examples of Medicaid fraud by patients
Patient fraud can take many forms. For instance, it is fraudulent to file a claim for services or products that are not actually received by the patient. Similarly, forging or altering receipts in order to be reimbursed by Medicaid is also fraud.
Obtaining medications or products that are not needed and then selling them on the black market is an egregious form of fraud. If a patient provides false information or uses someone else’s insurance to obtain services to which they are not entitled, that is also actionable fraud. Another very common type of patient fraud is “shopping” for doctors in order to obtain multiple prescriptions.
The 5-year look back period imposed by Medi-Cal law
In 2005, a law was passed that establishes a penalty period that applies to anyone who transfers their property within the five years prior to submitting their Medi-Cal application. The timing of any transfers you make is important because the period of eligibility starts when you submit your application. For that reason, ask your Los Angeles Medi-Cal attorney to help with your Medi-Cal planning.
Avoiding the appearance of fraudulent transfers in estate planning
A common misconception that clients have is that applying or qualifying Medicaid requires them to give away all of their property. Because of this misunderstanding, far too many clients attempt to simply transfer their assets to relatives in order to protect their eligibility. Unfortunately, this can be a big problem if it appears that you are hiding assets from Medicaid in order to qualify.
In order to avoid unknowingly committing fraud, there are a few things you should not do. First, do not contact your doctor to request a service that you don’t need. Likewise, don’t let anyone persuade you to see a doctor for care or services you don’t need.
Download a FREE estate planning worksheet today! If you have questions regarding estate planning, trust contests, or any other trust administration issues, please contact the Schomer Law Group either online or by calling us in Los Angeles at (310) 337-7696, and in Orange County at (562) 346-3209.
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