Overbilling Medicaid is also aggravated identity theft, says full 5th Circ

(Reuters) – A federal appeals court on Wednesday affirmed that overbilling Medicaid for services to a patient is not just healthcare fraud, but “aggravated identity theft” under a separate statute that includes a mandatory two-year sentence enhancement.

The full 5th U.S. Circuit Court of Appeals divided 10-8 on the question of whether David Dubin, who managed billing for his father’s psychology practice in Texas, violated the identity-theft law by falsifying the date and scope of services provided to “Patient L” – a real patient who had authorized him to bill Medicaid for the services provided.

A three-judge panel had affirmed Dubin’s convictions, one-year sentence for Medicaid fraud, and two-year sentence for identity theft related to Medicaid fraud in 2020. However, one judge pointed to a split in the federal circuits that led the 5th Circuit to grant en banc review last year.

Dubin’s lawyers at Gross & Esparza and O’Melveny & Myers argued that the enhancement statute must require misrepresentation of the patient’s identity, not just misrepresentation of services, or the “enhancement” would increase the sentence for every case of Medicaid fraud. They drew amicus support from the National Association of Criminal Defense Lawyers.

Source: Overbilling Medicaid is also aggravated identity theft, says full 5th Circ / Reuters

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