Spodek Law Group

Brooklyn Medicaid Fraud Lawyer

Medicaid fraud involves voluntarily and knowingly misrepresenting medical facts to obtain unauthorized benefits. The fraud includes any practice that leads to inconsistency with acceptable fiscal, business or medical practices within the healthcare industry.

Different Types of Medicaid Fraud

Medicaid fraud falls into four key categories. There is the medical billing fraud, unnecessary services, upcoding and unbundling. Medical billing fraud occurs when the medical facility provides bills for services not performed at the facility. It also involves cases where the facility continues to bill for services rendered even after the patient has been discharged or died. Frauds linked to unnecessary services involve cases where a provider falsifies diagnostic results and symptoms on a patient’s records and bills them to obtain payments.

Upcoding involves billing for Medicaid services using complex system codes. In this case, the offender is committing a fraud by billing for a more expensive procedure. Unbundling involves separating a group of procedures that have a special reimbursement rate. In this case, the provider unbundles them and bills them separately to get more money.

Possible Penalties for Medicaid Fraud in Brooklyn

The penalties for Medicaid fraud can be severe. The penalties range from jail terms to fines, probation and restitution. Jail terms can be anywhere from five years to life imprisonment. The terms depend on the scale of fraud and whether it leads to physical injury or death of the patient. Fines may range from thousands to hundreds of thousands of dollars.

In some cases, offenders may be put on probation. During probation, they are required to meet all probationary requirements, including regular attendance, employment standards and more. If the fraud resulted in loss of funds for the patient or insurance company, the offender may be ordered by the judges to reimburse the parties affected for the money lost.

Surviving a Medicaid Fraud Investigation

When you are suspected of committing a Medicaid fraud, you will receive a letter from the Bureau of Fraud Investigation. The letter contains all the details related to the fraud. It may also ask you to turn over documents and schedule a meeting with an investigator for an interview. By the time you meet him or her, the investigator has already gathered all the evidence he needs to pin you down.

There are ways you can survive medicaid fraud investigations. You can prove that the allegations have no basis by telling the investigators that you are one of those people who were flagged without committing any offense. If the investigators still insist on pushing on with the case, you can examine their evidence and look for faults. You can then show them these faults and convince them that the district attorney will not take their case.

You can also starve the investigators of information. By not giving them all the information they need, you will be making it difficult for them to file strong case against you. But be very careful with this technique. If the investigator discovers that you knowingly denied them information, they can press more charges.

Hire a Lawyer

Do not try to handle a Medicaid fraud investigation on your own. Any wrong move or misplaced priority can give the investigators the opportunity to file criminal charges against you. You need to contact an experienced Medicaid fraud lawyer before you even respond to the letter from the Bureau of Fraud Investigation. A Medicaid lawyer will protect your rights, prepare your defense and explore all options to ensure the investigators do not file criminal charges.

Do not take chances when you are facing Medicaid fraud charges. Take all the necessary precautions to protect yourself.