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Is this criminal fraud

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stephensel

Junior Member
I live in Georgia and have been divorced for almost 6 years now. I am responsible for paying all medical that is not covered by insurance. Every month she sends me prescription receipts and office visit charges which I have been paying. I found out yesterday that my X wife has my daughter on Medicaid and has had her on Medicaid for the past 5 years. She has been paying all of my daughters medical bills that insurance does not cover through her free Medicaid debit card and then turning around and billing me for the same amount. At this point she has stolen almost 15k from me in medical charges and I want justice. I called my local police department and they said that I would need to talk to a judge and let him decide if its civil or criminal. Is there anything I can do to make sure this gets handled as a criminal case? If this goes to civil I will never see the money because she is lazy and has not worked in over 13 years and will probably never work.

She has committed unemployment fraud in the past and can prove it. Would her history of fraud make things easier to move forward?
 


quincy

Senior Member
I live in Georgia and have been divorced for almost 6 years now. I am responsible for paying all medical that is not covered by insurance. Every month she sends me prescription receipts and office visit charges which I have been paying. I found out yesterday that my X wife has my daughter on Medicaid and has had her on Medicaid for the past 5 years. She has been paying all of my daughters medical bills that insurance does not cover through her free Medicaid debit card and then turning around and billing me for the same amount. At this point she has stolen almost 15k from me in medical charges and I want justice. I called my local police department and they said that I would need to talk to a judge and let him decide if its civil or criminal. Is there anything I can do to make sure this gets handled as a criminal case? If this goes to civil I will never see the money because she is lazy and has not worked in over 13 years and will probably never work.

She has committed unemployment fraud in the past and can prove it. Would her history of fraud make things easier to move forward?
Here is a link to the Georgia Office of the Attorney General on the Medicaid Fraud Control Unit: https://law.georgia.gov/medicaid-fraud-control-unit

You can report your ex-wife's suspected Medicaid abuse and there will be an investigation.
 

quincy

Senior Member
I called them yesterday and they said they only investigate fraud by providers.
Did you have the chance to read the information provided in the link?

From the link it says that Medicaid recipient fraud is handled by the Georgia Department of Community Health and is prosecuted by your local District Attorney. Here is the link to local DAs: http://www.pacga.org/site/fyp

You should gather together whatever evidence you have of your ex-wife's Medicaid abuse.
 

PayrollHRGuy

Senior Member
The police were wrong. It isn't up to the judge to decide if it is a civil or criminal matter. Further, the two are not exclusive.

If you want a chance of getting your money back you need to contact a lawyer.
 

quincy

Senior Member
The police were wrong. It isn't up to the judge to decide if it is a civil or criminal matter. Further, the two are not exclusive.

If you want a chance of getting your money back you need to contact a lawyer.
Or the DA, as recommended. If prosecuted successfully, restitution can be ordered.
 

Zigner

Senior Member, Non-Attorney
Restitution to whom? In this case, restitution would go to Medicare, not the OP.
 

quincy

Senior Member
I live in Georgia and have been divorced for almost 6 years now. I am responsible for paying all medical that is not covered by insurance. Every month she sends me prescription receipts and office visit charges which I have been paying. I found out yesterday that my X wife has my daughter on Medicaid and has had her on Medicaid for the past 5 years. She has been paying all of my daughters medical bills that insurance does not cover through her free Medicaid debit card and then turning around and billing me for the same amount. At this point she has stolen almost 15k from me in medical charges and I want justice. I called my local police department and they said that I would need to talk to a judge and let him decide if its civil or criminal. Is there anything I can do to make sure this gets handled as a criminal case? If this goes to civil I will never see the money because she is lazy and has not worked in over 13 years and will probably never work.

She has committed unemployment fraud in the past and can prove it. Would her history of fraud make things easier to move forward?
See what I have bolded above.

For the ex-wife to be criminally prosecuted, he will want to file a Medicaid abuse complaint with his local DA.
 

stephensel

Junior Member
Thanks everyone.

I did find a link to the inspector general for my state that handles these cases for the "Georgia Department of Community Health". I will also file with the DA and talk to Medicaid as well. After doing some reading it turns out that she can only get Medicaid for our daughter if she is claimed as a dependent of hers and the divorce decree states that I get to claim her as a dependent every year for the tax break. So she probably lied to Medicaid and filed a false claim with them on top of the double billing.

I don't care about getting the money back. I just want her to pay for all of her lies and deceitfulness.
 

Zigner

Senior Member, Non-Attorney
Thanks everyone.

I did find a link to the inspector general for my state that handles these cases for the "Georgia Department of Community Health". I will also file with the DA and talk to Medicaid as well. After doing some reading it turns out that she can only get Medicaid for our daughter if she is claimed as a dependent of hers and the divorce decree states that I get to claim her as a dependent every year for the tax break. So she probably lied to Medicaid and filed a false claim with them on top of the double billing.

I don't care about getting the money back. I just want her to pay for all of her lies and deceitfulness.
You're confused about the taxes. You're allowed to claim the dependent exemption, but that does't have a factor in Medicaid's determination of dependency.

ETA: I further suggest that you seek therapy to get over this woman.
 

quincy

Senior Member
Thanks everyone.

I did find a link to the inspector general for my state that handles these cases for the "Georgia Department of Community Health". I will also file with the DA and talk to Medicaid as well. After doing some reading it turns out that she can only get Medicaid for our daughter if she is claimed as a dependent of hers and the divorce decree states that I get to claim her as a dependent every year for the tax break. So she probably lied to Medicaid and filed a false claim with them on top of the double billing.

I don't care about getting the money back. I just want her to pay for all of her lies and deceitfulness.
You are moving in the right direction if you want your ex criminally charged. A complaint to the DA should eventually result in an investigation.

If you are not the custodial parent, your ex-wife can claim your daughter as a dependent on her taxes. To satisfy the terms of your divorce decree, you must have her sign the exemption over to you.
 

commentator

Senior Member
Forget about that she has committed unemployment fraud in the past. If she has not worked in 13 years or so, that unemployment fraud is WAY in the past. And it is inside the Georgia unemployment system which is a closed system, and nobody really cares what happened with her unemployment claim many years ago. Try something else.
 

Taxing Matters

Overtaxed Member
She has committed unemployment fraud in the past and can prove it. Would her history of fraud make things easier to move forward?
Her past UI fraud would likely not be admissible against her at the trial because the general principle applied is that the jury is to take into account only those facts that tend to prove or disprove whether she committed the Medicaid fraud. The unemployment fraud was done years ago and has no connection to this Medicaid matter and thus would not be relevant to proving the Medicaid fraud.
 

Taxing Matters

Overtaxed Member
And it is inside the Georgia unemployment system which is a closed system, and nobody really cares what happened with her unemployment claim many years ago. Try something else.
The fact that it is a “closed system” doesn't mean anything if she was charged or convicted with unemployment fraud as the criminal prosecution records are public. While it did occur years ago, the courts may still care about it when it comes to sentencing her if she is convicted on the Medicaid fraud.
 
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