Practicefirst would like to share with you January’s Medicaid Update, received in February, which included an article regarding Identify Theft and Medicaid Mills.
Medicaid Mills are alleged medical clinics which use patients as pawns in schemes to collect on fraudulently submitted claims. Typically, these “mills” are operated by former healthcare providers excluded from Medicaid participation due to fraud or other healthcare offenses. The services submitted are never rendered or not medically necessary. These “mills” obtain the identity of a licensed healthcare provider who was alleged to be the service or referring provider. A specialist is asked by a stranger with no verifiable professional standing to order tests or read the results without any knowledge of the patient.
Sometimes, new practitioners who have not yet learned professional norms are exploited to obtain their billing credentials or are directed to perform activity beyond the scope of their licensing. Once a “mill” has a physician’s license number, it will appear that they are submitting the fraudulent claims.
Providers are advised to be alert for these signs of a “medical mill.” Providers should review their ordered services frequently to ensure they are valid. Not doing so could lead to consequences that could have a devastating impact on your career.