Criminal prosecution of cases involving medicaid fraud are on the rise in New York State, and it is the job of the New York State Office of the Medicaid Inspector General (OMIG) to investigate and prosecute individuals, entities and/or health care providers who intentionally commit medicaid fraud http://www.ny.gov/agencies/office-medicaid-inspector-general.
The Medicaid program is run by State and Federal governments, as such if you are accused of medicaid fraud you may be subject to prosecution under State and Federal law. Here, we will examine the charge of medicaid fraud, who can be charged, penalties, defenses, and other legal aspects involving medicaid fraud to determine if you need an experienced NYC medicaid fraud lawyer to protect your rights.
Pursuant Title 18 U.S. Code §1347 a charge of medicaid fraud involves the intentional misrepresentation of facts in order to receive an unauthorized or ineligible benefit http://www.law.cornell.edu/uscode/text/18/1347. New York State also has penal laws that classify medicaid fraud anywhere from a class A misdemeanor, to fraud in the first degree, which is a class B felony and carries more significant penalties.
What to do if you have been charged with medicaid fraud?
Allegations of medicaid fraud should be taken very serious. The first thing you should do is examine whether or not there is any merit to the allegations, or if it is simply the result of harmless error, or inadvertence. Second, determine if the allegations are still at the investigative level or if formal charges have been filed. If formal charges have been filed you should speak with an attorney as soon as possible.
Who commits medicaid fraud?
Medicaid can be committed by any person or entity that intentionally provides medicaid with false or inaccurate information or documentation to receive a benefit for which they would not otherwise be entitled to. However, the medicaid fraud is commonly committed by patients, doctors or medical providers, and/or insurers.
There are numerous ways a patient may be committing medicaid fraud including, but not limited to 1). Submitting a claim for services or treatment they did not receive. 2). Providing false or inaccurate information on the application for benefits; or 3). Using another persons medicaid coverage for unauthorized treatment or services.
Medical Provider Fraud
There are also numerous ways a doctor or medical care provider can take advantage of, and defraud the medicaid program. Three commons frauds are: 1). Billing medicaid for services or treatment not rendered. 2). Accepting or receiving bribes or payoffs for patient refers ; and 3). Ordering unnecessary tests and/or scheduling excessive non-essential visits and treatments.
Insurers are also not immune to the potentiality of committing medicaid fraud. In fact, common frauds committed by insurers consist of the following: 1). Denying a valid claim submitted by a patient or healthcare provider. 2). Accepting a claim that they know is unacceptable or in violation of benefit policies and procedures; and 3). Falsifying information to a participant in order to sell a particular plan, product or service.
The severity of the penalties you face with a charge of medicaid fraud depends greatly on the individual facts of your case. However, this charge can be prosecuted under State and Federal, which range from a Class A misdemeanor, to a Class B felony. Needless to say, the penalties can also range from fines and formal probation, restitution or incarceration.
Not every charge of medicaid fraud ends in a conviction. In fact, an experienced nyc medicaid fraud lawyer can immediately begin formulating your defense or presentation of mitigating circumstances that help exonerate or reduce the fallout of these allegations. In any event, you should be with a nyc medicaid fraud lawyer as early in the case as possible. In many cases a skilled attorney can contact the right people in charge of the prosecution, in order to subvert any further unnecessary investigation into the matter by asserting a strong and compelling defense.
Other Legal Ramifications
In addition to the legal charges and penalties associated with medicaid fraud, you may also be subjected to other legal ramifications as well. For example, a doctor who has been convicted of medicaid fraud can lose his or her license to practice medicine, or can have other professional licenses revoked or suspended. Likewise, patients who have been found guilty of medicaid fraud may be ineligible to receive such benefits in the future, despite need or eligibility. Insurers who commit medicaid fraud can lose their professional license and be permanently barred from ever participating in the medicaid program.
Allegations and/or charges of medicaid fraud are very serious. If you have been accused of medicaid fraud it is imperative that you speak with an experienced criminal defense attorney right away.
Medicaid fraud runs rampant throughout New York City. It is not familiar to just a specific group of people. Those who commit Medicaid fraud come from all walks of life. However, their status in society does not matter to the courts in New York City.
What is Medicaid Recipient Fraud?
Medicaid is a benefit awarded to low income, disabled and poor people. It is funded by state government via the federal government. Medicaid fraud involves providing false information to the government in an attempt to receive benefits.
Medicaid fraud does not just involve false information, but the omission of information as well. The different ways of committing Medicaid recipient fraud are as follows:
• Submitting an application (including recertification) with incorrect information
• Not disclosing your true income
• Not disclosing your spouse’s income or your household income
• Not disclosing income from a rental property
• Not disclosing income from your hobby
• Income reported does not correspond with your expenses
• Hiding information about your income or assets
• Reporting a false address (living outside of New York City)
• Selling your prescription medications paid for by Medicaid
• Filling counterfeit prescriptions
• Receiving benefits you are not entitled to
• Loaning your Medicaid card to someone else
• Owning multiple Medicaid cards
What Prompts an Investigation?
The investigation begins with you. Something about you or your actions triggers the Bureau of Fraud Investigations (BFI) in New York City to look at you more closely. If you took money – like a small business loan, it can be misconstrued as income. BFI is tasked with investigating those individuals whose actions constitute Medicaid fraud. It falls under the umbrella of the Human Resources Administration (HRA). BFI is not a lightweight. This division is responsible for the prosecution of many Medicaid recipient fraud cases in New York City. And, now, you are on their radar. A new case has been opened. There are several reasons why you could have been flagged. Perhaps you were just simply reported to the HRA. Maybe your income tax return contains a different address. Perhaps there has been suspicious activity with your bank account. Whatever the reason, you can rest assured that the investigators have already done the required legwork. This is what they have been trained to do. Their years of experience range from 10 to 30 years or more. They are professionals who are adept at performing intensive investigations. Although the investigators are not law enforcement employees, they do have the same mindset as them. They know how to collect evidence. They know how to testify in court. These Medicaid fraud investigators should not be underestimated.
By the time you receive an interview letter from HRA, the investigators have already gathered the necessary evidence against you. They have already verified your income with your employer. They have your bank account information. They have copies of your deeds and mortgages. These people are serious.
The Interview Letter
Let’s be clear. This will not be an interview. This will be an interrogation. By the time you receive this letter from the HRA, all evidence has been gathered, and it has been determined that you are indeed a Medicaid fraudster. As they see it, this interview just gives you the opportunity to incriminate yourself. And, by doing so, you just give them more ammunition in their case against you.
Potential Penalties for Medicaid Recipient Fraud
Whether you go to jail or not is dependent upon your case. If HRA has a strong, solid case against you, then you could possibly be imprisoned. However, if your case is weak, then other arrangements could possibly be made. But, the bottom line is that you should not plead guilty if you did not commit Medicaid fraud.
Penalties for Medicaid recipient fraud run the gamut from restitution to severe prison sentences. Such penalties also include the following:
• Ineligibility for Medicaid benefits
• Civil judgment
• Property lien
• Wage garnishment
• Revocation or suspension of professional license
Medicaid recipient fraud in New York City is a serious offense. Actually, it is a felony. You could be charged with grand larceny or welfare fraud. And, if you plead guilty to either, then you will have a criminal record forever.
When you are faced with a Medicaid fraud charge, you should immediately hire an attorney who has experience in this field. You need someone who knows how to handle such a case. Someone who will tell you what your rights are in such a case. For example, you may not know that you are not required to speak with the HRA investigators. Let an attorney lead you to your case scenario.
Allegations of Medicaid recipient fraud are common in New York City along with the rest of the United States, in no small part because whistleblowers can receive financial compensation if their tip turns out to be accurate. If you believe you’re being investigated for Medicaid recipient fraud or you’re currently dealing with a fraud charge, it’s in your interest to contact a New York City criminal defense attorney who can help you get the result.
What Happens with a Medicaid Recipient Fraud Case?
New York has a fraud investigation department that handles cases of potential Medicaid fraud. There are a few steps to any Medicaid fraud case.
There could be many reasons for why the department would choose to investigate you. They may have received a tip from one of those aforementioned whistleblowers, or they may have gotten ahold of information that conflicts with something in your original Medicaid application, such as proof of income that’s higher than the amount you listed.
In the first stage of the case, the fraud department will gather evidence against you. It may even send investigators to monitor you during the day. If you know about the potential Medicaid fraud charges at this time, it’s a good idea to get in touch with a nyc medicaid fraud lawyer already. A nyc medicaid fraud lawyer can advise you on what to do and ensure that any investigators follow the law.
The next stage of the case will be when the fraud department notifies you of a potential case of Medicaid fraud, usually with a letter that it mails to you. The letter will ask you to come talk to the fraud department and bring in certain documents, which will vary depending on the case. The documents requested can give you some indication of what evidence the fraud department has compiled against you.
After the meeting date, whether you attend or not, the fraud department will decide how to proceed with your case. It may come to a settlement agreement with you, or it could send the case over to the district attorney for prosecution.
Since Medicaid is a program for people with low incomes, it’s considered a type of welfare, and that means in New York City, Medicaid fraud is filed under the broader category of welfare fraud, which has five degrees, the least severe being a class A misdemeanor and the most severe being a class B felony. The degree of your welfare fraud depends on how much you obtained in Medicaid benefits through the fraud.
Every case is different, and the circumstances of your case will determine what penalties you can receive. Any degree of welfare fraud has the possibility of time in jail and financial penalties. You could also end up disqualified from ever receiving Medicaid benefits again if you’re found guilty.
Although jailtime is possible with Medicaid fraud, it’s rare and probably won’t happen unless you fraudulently obtained a very high amount of benefits or have several prior offenses. A fine or restitution is much more likely. A nyc medicaid fraud lawyer can help you negotiate the deal to potentially avoid jailtime and get a lower fine amount.
How Can You Defend Yourself Against Charges of Medicaid Fraud?
One of the biggest mistakes people make when they’re charged with Medicaid recipient fraud is going in without figuring out their defense first. The fraud department loves this, and their goal is for you to come in, answer everything they ask and give them all the documents they requested. If you do that, you may voluntarily give them all the evidence they need against you.
Your defense starts the moment you learn there’s a case being built against you. You and your nyc medicaid fraud lawyer should go over the information you provided in your Medicaid application and see if any of it is no longer accurate. It’s your responsibility to keep that information updated with any life changes, such as a marriage or a new job.
If you’ve received a letter from the fraud department, you and your nyc medicaid fraud lawyer can use their requested documents to get an idea of the case being built against you. Your nyc medicaid fraud attorney can then look for potential issues with the case and advise you on how to handle the situation. They can also accompany you to the meeting, tell you when you shouldn’t answer a question and represent you if the district attorney gets the case.
Our New York City law firm is full of experienced NYC criminal defense lawyers who know how to handle charges of Medicaid recipient fraud. We can analyze your case, help you build your defense strategy and either try to get the charges dropped or negotiate a favorable deal for you.
Medicaid fraud often occurs in NYC, under ORC 2913,40. A letter issued from NYC demonstrating the need for assessment of entitlement for medical health insurance can be an indication of Medicaid fraud. It is advisable to engage a skilled nyc medicaid fraud lawyer on receipt of an investigation letter. Below are Medicaid Recipient Frauds:
Use of fictitious address while applying for Medicaid is illegal. If you are an ineligible recipient and you try to forge information on the application to receive Medicaid, you are committing a crime. Eligible recipients must notify the agency before ineligibility of the next recertification. Otherwise, they are committing an offense.
When applying for Medicaid as a benefit recipient, you are supposed to provide real disclosure of your financial status and that of the spouse. You are also supposed to make it known to the program of any changes in your income. Most of Medicaid recipient who conceals their income or assets get charged for Medicaid fraud cases.
Transferring your Medicaid to another person or acquiring multiple Medicaid cards is illegal. Some beneficiaries collaborate with providers to fake, change the prescription, and financial orders. These practices are criminal acts, and one can face court charges or severe penalties for these misconducts.
Other practices that are considered fraud include receiving duplicative, more or different health care services or supplies knowingly. Trading items or drugs received from Medicaid program is contrary to the law. Being ineligible and giving false details on the application, to receive Medicaid can also land you to severe Medicaid fraud charges.
Medicaid fraud penalties vary depending on the results from the investigators. The beneficiary may be paid full premiums for the time they were not eligible for the benefit if the case has no criminal allegations. However, monetary penalties may be charged on the beneficiary after the completion of investigations.
In scenarios where the case is referred to civil court, the judgment can be in contrast to their assets. Charges can be attached to the recipient paychecks, personal property or even their real estate. If the criminal allegations are the beneficiary, then it is likely for them to face a prison sentence. The recipient can also lose their professional licenses or be deported if they are not in possession of legal immigration documents. Additionally, the court may cancel the recipient eligibility to participate in Medicaid.
Due to the chances of facing severe consequences, you should contact NYC Medicaid Lawyer once you receive a letter indicating the need for investigations. Never try to handle Medicaid Fraud cases on your own. A skilled attorney will assist you in compiling your evidence, sensitize your rights, and give underlying options.
The barrister can convey with the investigator on your behalf. Contracting an attorney saves you time, severe criminal and civil consequences as well as money. It is important to note that, by the time you receive a review demand letter, the investigator has gathered evidence against you. Make sure not to say anything or provide any documents requested, as this is the work of your notary.
The Centers for Medicare and Medicaid Services (CMS), implemented tools to prevent waste, improper payments, and fraud in the Medicaid program. These systems are used to improve further partnership with state and law enforcement stakeholders. They detect and prevent fraud by use of a multidimensional approach. The technology involves screening providers through the use of predictive modeling, the same skill used for credit cards. As a recipient, report any suspicious activities noticed through your bills or over phone calls.
Recipients have a considerable responsibility in controlling Medicaid fraud. Make sure not to sign any blank forms when you visit a facility. It is your legal responsibility to monitor your benefit plan. The signing of blank forms increases the chances of forgery and increased billing.
Understanding of Medicaid benefits is paramount. Be aware of offers for free medical scanning and testing covered by Medicaid. Make it clear to your medical providers, to always contact you before billing Medicaid. These will give you control of your plan.
Medicaid recipient has to work closely with the provider, to identify any illegal activities committed by Medicaid supplier. The recipient should keep records of the period of services, provider details, services rendered, and any other services as ordered by the provider. Invoicing of services not offered is illegal, and the recipient is supposed to report.
Other Legal Aspects of the Crime
Some drug prescription companies form a cartel with the business owners or insurance companies that manage drug – benefit plan. They award pharmacies and insurers who convince recipients to switch prescriptions. It is essential to understand the side effects or risks that may occur from use of different drugs. As a recipient find how the switch will financially affect your benefit plan.
Most companies use fraudulent to help sell their products. They access your mail details and send clipped mails or concealing materials to you. Differentiating positive advertising messages from trickery marketing is essential. It is advisable to report any doubtful solicitation received.
Spodek Law Group consists of service driven NYC medicaid fraud lawyers who will understand potential criminal and civil penalties of your medical investigation. We have vast experience in law and our skilled Medicaid Fraud attorneys will help you, prepare a complete defense and make right decisions. If you are served with an investigation demand letter, reach to our nyc medicaid fraud lawyers who are always available to help and respond to any queries. We understand specific laws and regulations governing Medicaid, and this has kept us on the record for winning tough cases.
Medicaid fraud is a crime that is taken very seriously in the United States, and statistics show that the rate of Medicaid fraud has been increasing alarmingly in many states, including in the state of New York. The Office of the Medicaid Inspector General is responsible for protecting the interest of the medical providers, taxpayers, and recipients of Medicaid. The Medicaid Inspector General is primarily responsible for catching the culprits behind the Medicaid fraud or who abuse the Medicaid program. There is a program in place in the state of New York that encourages the people to report any kind of abuse of Medicaid program they witness, notice, or come to know about. It helps the law enforcement agencies and other relevant authorities to take necessary actions against the offenders.
The benefits associated with Medicaid and its funds can be misused in various ways. It can be done by the medical provider as well as the patient, and such activities use up a lot of resources of the government, depriving the people of such benefits who are actually in need of it. Many different actions can lead to being named as Medicaid fraud, such as billing falsely for the purchase of equipment or medical services, which in actuality were never bought or availed in the first place, respectively.
When the people bill Medicaid for a doctor’s visit that never actually occurred, it amounts to Medicaid fraud. If the physician bills the patient and also the Medicaid, it is a textbook example of abuse of Medicaid program. If the doctor provides patients with the general medicine/drug but bills Medicaid for branded drugs, it amounts to Medicaid fraud as well. Making separate bills for different services instead of making one comprehensive bill and including expenses that are unrelated to Medicaid claims is also a kind of Medicaid fraud. If the doctor engages in up-billing, which means billing Medicaid for an expensive service than the one provided to the patient, it is a form of Medicaid abuse.
Those mentioned above are some of the examples of how the doctors engage in Medicaid fraud or abuse, and now let us look into how the patients can also abuse the Medicaid program. If the patients give their Medicaid card to someone else to avail Medicaid benefits, it is an abuse of Medicaid program. If the patients don’t report their actual income to the Medicaid, and if they are not eligible for the Medicaid, but continue to receive Medicaid benefits, it is a Medicaid fraud. If the patient’s health insurance provides adequate coverage for the illness yet, the patient fails to return the Medicaid benefits; it amounts to Medicaid fraud.
There are provisions in the law that can lead to incarceration for the people convicted of committed Medicaid fraud. In such situations, it is crucial that you consult an experienced New York Medicaid Fraud Criminal Attorney. A criminal attorney with specialized expertise and experience in handling Medicaid fraud lawsuits would be able to help defend you in the court of justice and ensure that incarceration is checked off the list of possibilities.
Medicaid runs a highly successful incentive program that encourages people to report any kind of suspicious activities they note that might be an instance of Medicaid fraud. People reporting Medicaid fraud can get close to $1,000 if the frauds they report are verified. People are rewarded under the incentive program when they report any suspected case of fraud related to Medicaid or if the reported fraud is validated as a potential fraud by other concerned authorities, including the Zone Program Integrity Contractor and the Medicare Drug Integrity Contractor. There are many different instances where reporting by people of any kind of Medicaid fraud can be rewarded. The idea here is to spread awareness of this highly present fraud being carried out in our society and to ensure that the taxpayer’s money is not misused.
People who have committed Medicaid fraud can be punished with penalties with an intensity corresponding to the seriousness of the fraud perpetrated. The defendant in Medicaid fraud can face up to few months to five years or even life imprisonment in jail, especially if it has caused physical injury or death of the patient. The defendant can also be given probation term during which he/she has to abide by all the probation guidelines, attend probation meetings, and meet the employment standards set for the probation period.
In many cases of Medicaid fraud, the defendants have to face the jail term as well as pay the fine or either of the one. In some of the cases, the fines can run into tens of thousands of dollars. The physicians charged with Medicaid fraud due to faulty administration may also face administrative sanctions. In some of the cases, the doctor’s license may also be canceled or they may be barred from participating in the Medicaid program. Hiring an experienced NYC medicaid fraud lawyer specializing in Medicaid fraud is an ideal solution to glide through the legal hassles when charged with Medicaid fraud or reporting its abuse with you as a victim.
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