Spodek Law Group

NYC Medicaid Fraud Lawyers

New York Medicaid recipient fraud criminal defense law firms

Every year in the United States, healthcare fraud costs taxpayers an estimated $270 billion. Of this, approximately $140 billion is due to Medicaid fraud alone. These staggering sums add up to significant portions of the total U.S. federal budget, making the reduction of Medicaid fraud and healthcare fraud in general a top priority for both state and federal enforcement bodies.

The state of New York has not been excepted from the scourge of Medicaid fraud. As a result of sharply increasing rates of the crime throughout the state, New York State is now devoting more resources than ever to stopping fraud of all kinds taking place through its Medicaid system. This has resulted in a huge increase in the number of arrests. Many of those arrested have strong defenses against the accusations and have simply been caught up in the zeal to prosecute as many Medicaid fraud cases as possible.

If you find yourself under investigation for Medicaid fraud in the state of New York, the first thing that you should do is to contact a competent nyc medicaid lawyer. Medicaid fraud cases are often highly defensible, and a good nyc medicaid lawyer can make the difference between prison time and the dismissal of a case.

Don’t be fooled by Human Resource Administration letters

The state of New York has a quirk in the way that Medicaid fraud cases are investigated. Rather than being investigated by police or detectives, as are almost all other types of crime, Medicaid fraud cases are, instead, investigated by the Human Resources Administration, the same agency that handles such things as food stamps and child welfare benefits.

When someone is under investigation for Medicaid fraud, the first sign they will usually get is a letter from the HRA. The letter is often written in benign-sounding bureaucratic language and simply requests that the recipient come in for an interview with an agent.

Do not be fooled by the apparently innocent tone of these letters. If you receive a letter from the HRA requesting that you come in for an interview regarding your Medicaid usage or benefits, it is almost guaranteed that you are the target of an investigation regarding serious Medicaid fraud. It is likely that the agents already have spent dozens or even hundreds of hours investigating your case and know far more about you and your situation than they will let on. The sole reason that they have asked you to come in for an interview is to induce you to make self-incriminating or self-impeaching statements that they can use to create a slam-dunk case against you.

It is absolutely imperative that, at this point, you get an experienced and skilled nyc medicaid lawyer who specializes in New York Medicaid fraud cases on your side. Although the investigators work for a civilian agency, Medicaid fraud is an extremely serious crime that can result in major fines, restitution and even lengthy prison sentences. You are usually under no legal obligation to talk to the investigators. And an experienced nyc medicaid lawyer who knows that process well can help you navigate the often tricky waters of the HRA and the court system.

Medicaid cases are some of the most defensible there are

Even if you have clearly acted improperly and have deliberately committed a crime, the chances are high that with the right nyc medicaid lawyer you will be able to negotiate a settlement that does not involve jail time. But if you really have not intended to commit any crime, there is a good possibility that the charges can be dismissed outright.

Medicaid fraud cases have some unique features that allow nyc medicaid lawyers to put up particularly strong defenses and negotiate good settlements for their clients. There are often many mitigating factors present. For example, if the prosecution cannot show that an oversight, such as not fully reporting income from a side job, was deliberate, the default assumption will be that it was an innocent mistake. Raising enough doubt of this kind can make the more serious charges inappropriate. If prosecutors cannot show that there was definite intent to defraud, the felony charges associated with Medicaid fraud will often be dismissed.

Another unique aspect of Medicaid fraud cases is that prosecutors know that a very high percentage of defendants who are charged with these crimes will go to trial. This is primarily due to the fact that the collateral consequences of being guilty of Medicaid fraud, such as permanent disqualification from all future benefits and losing one’s medical licenses, are so severe that many patients will not accept a plea deal.

This is where the services of an experienced nyc medicaid lawyer can really make a difference. The mere presence of an experienced lawyer, who the prosecutor knows will mount a strong defense, is often enough to dissuade them from risking hundreds of man hours and thousands of dollars in court resources prosecuting a case that they may well ultimately lose.

One of the biggest concerns in healthcare today, Medicaid fraud is a growing problem in many states. According to the Government Accountability Office, in 2015 alone improper payments for services not covered by Medicaid or for services that were billed but never rendered totaled more than $29 billion. Because of this, funds that could otherwise be used for legitimate services are instead wasted on these fraudulent claims, which results in increased costs for many services. More information about this can be found at www.ncsl.org/research/health/medicaid-fraud-and-abuse.aspx. If you find yourself being charged with Medicaid fraud, it’s a serious matter that could lead to significant financial penalties as well as jail time.

Defining Medicaid Fraud
The basic definition of Medicaid fraud is knowingly using false information to apply for and receive Medicaid benefits. Because eligibility for this program revolves around a person’s level of income, this is usually the area that is most often misrepresented. However, failing to disclose assets such as real estate is also considered fraud, as is failing to notify your Medicaid office of any changes to your financial or living situation. Even if you simply forget to make the notification, you can still be accused of fraud.

What are the Penalties?
Since Medicaid fraud falls under welfare fraud, there are varying types of offenses depending upon how much money was received. For lesser amounts that total no more than $1,000 dollars, it would be classified as a misdemeanor. However, anything above that amount becomes a felony, with the most serious being a first-degree felony, which is receiving fraudulent Medicaid benefits totaling more than $1 million. Needless to say, the higher the amount of fraudulent benefits you received, the more severe the penalties. In most cases you are fined and required to pay back any funds you obtained under false circumstances, but are rarely sentenced to prison for your offense. This is due to the large number of pending Medicaid fraud cases, which leads many prosecutors to be willing to negotiate a plea agreement with defendants, resulting in lesser penalties.

Are There Mitigating Factors?
When people hear of Medicaid fraud cases, most automatically assume the case is open and shut. However, that’s often not the case at all. In fact, there are numerous mitigating factors that usually come into play in these cases. When these emerge, a person who appeared guilty may all of a sudden be found innocent of all charges. This is due to being able to prove that the information provided on an application was complete and accurate, and is still accurate to the of their knowledge. However, if there is information on the application that is inaccurate, that doesn’t necessarily point to fraud. Instead, being able to prove an honest mistake occurred will resolve the situation, although it’s vital you be able to prove this. And remember, these fraud investigations usually result from tips provided by a whistleblower, who will usually be compensated financially for the information. Therefore, it’s quite possible mistakes can occur, so be prepared for this possibility.

How Do I Defend Myself Against These Charges?
While these cases can be intimidating to those being accused of Medicaid fraud, it doesn’t have to be that way. While you may receive a letter from Medicaid fraud investigators requesting your presence in their office to discuss the case, there are certain steps you can take. For starters, gather all documents you have related to the matter, make copies of everything, and take them with you to the meeting. However, it’s crucial that you not go to that meeting alone. Instead, contact a knowledgeable and experienced criminal defense nyc medicaid lawyer who specializes in Medicaid fraud. After doing so, discuss your case thoroughly and go over your options. In most situations, your nyc medicaid lawyer will decide investigators lack the evidence needed for a conviction, or that they do have evidence which could result in a guilty verdict. In either case, have your lawyer attend the meeting with you. If they do, they may be able to negotiate an agreement in your favor, especially if the evidence seems to be against you.

Don’t Go It Alone
Regardless of the circumstances in these cases, don’t choose to go it alone. Investigators often count on this, hoping you will be too intimidated to think clearly. Instead, schedule a consultation with an attorney as soon as possible after receiving notification from investigators. According to the website Healthresearchfunding.org, more than 40 percent of Medicaid payments in New York are deemed “questionable,” making it more likely that investigators will take a closer look at your application. So rather than let yourself be caught off-guard by zealous investigators who may be determined to find fault no matter the circumstances, hire an experienced and knowledgeable Medicaid fraud criminal defense attorney to help you navigate this complex process.