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Queens Medicaid Fraud Lawyer

With today’s healthcare system being so complex, there are many opportunities to commit Medicaid fraud. Because of this, it’s estimated that five percent of Medicaid funds are spent on fraudulent claims. While this may not sound like much, the amount is staggering. According to the National Council of State Legislatures, five percent amounts to almost $29 billion wasted annually on false claims. Due to the amount of waste, there are severe penalties for those who are convicted of Medicaid fraud. To learn more about the various types of Medicaid fraud and the penalties associated with them, here are some important facts to keep in mind.

Types of Medicaid Fraud
When it comes to Medicaid fraud, the most common type is submitting false documents or failing to submit documents that contain completely correct information. These can include documents that fail to report all sources of income, employment, or assets. However, the most expensive form of Medicaid fraud is what’s known as phantom billing. Done by a healthcare provider, this involves billing the government for medical tests and procedures that were unnecessary or never provided, and also medical equipment that was never provided. In some situations, the patient may work directly with the healthcare provider to defraud the government. When this happens, the patient will agree to lie in exchange for receiving a share of the money.

Medicaid Fraud Penalties
When someone is found guilty of Medicaid fraud, the penalties can vary depending upon the severity of the crime. Since it is usually classified as a felony, prison time is a possibility, and can vary in the number of years based on such factors as the amount of money stolen or if the person has a prior criminal record. However, in most cases, fines and restitution are used in place of prison sentences. If a person has violated the False Claims Act, the fines can be as much as $11,000 per false claim, which can add up quickly. In addition to these fines, civil damages of up to $50,000 per violation can also be awarded. But in cases where the amount of money stolen was not very high, most courts opt for restitution as the most reasonable form of punishment.

Defenses to Medicaid Fraud
If you have been charged with Medicaid fraud, there are a variety of defenses you and your attorney can use during your case. One of these is that you were unaware of being overpaid, and simply have not returned the money. And since federal law allows a person to return excessive payments within 60 days, it is an option to consider. However, additional defenses can often be more effective. These can include coding and billing errors, where a defendant can claim they were not aware of the errors since they had little or no knowledge of coding and billing procedures. And yet another defense can involve being falsely accused by someone attempting to pin the crime on someone else, or seek a lighter sentence for themselves if they can prove they had an accomplice. However, if this defense is used, it’s crucial that you can provide accurate records that will show you played no part in the crime.

Hire an Experienced Attorney
If you find yourself charged with Medicaid fraud, hire the services of an attorney with experience and knowledge in this area. Otherwise, you may find yourself facing prison times, fines, and possibly civil damages. For more information on the impact Medicaid fraud plays in healthcare, visit www.ncsl.org/research/health/medicaid-fraud-and-abuse.aspx or www.medicare.gov. In doing so, you’ll have a better understanding of the crime, as well as the possible consequences.

by Leonard on Spodek Law Group
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