NYC Medicaid Fraud Lawyers

At Federal Lawyers, we understand the gravity of Medicaid fraud charges and the devastating impact they can have on your life and career. That’s why our team of seasoned NYC Medicaid fraud lawyers is committed to providing you with the aggressive defense you need to protect your rights and your future.

What is Medicaid Fraud?

Before we dive into the legal intricacies, let’s define what Medicaid fraud actually is. Medicaid is a federal and state-funded healthcare program designed to provide medical assistance to low-income individuals, families, and those with disabilities. It’s a vital resource that helps millions of Americans access the care they need.However, Medicaid fraud occurs when someone intentionally submits false or fraudulent claims to the program for payment. This can take many forms, such as billing for services that were never provided, providing unnecessary or inferior services, or misrepresenting a patient’s diagnosis to receive higher reimbursement.Both individuals and organizations, including healthcare providers, hospitals, clinics, and nursing homes, can commit Medicaid fraud. And the consequences can be severe, ranging from hefty fines and loss of licensure to criminal prosecution and even imprisonment.

Common Types of Medicaid Fraud

Medicaid fraud can manifest in various ways, and it’s crucial to understand the different types to better protect yourself. Here are some common examples:

Billing for Services Not Rendered

This is perhaps the most straightforward form of Medicaid fraud, where a healthcare provider bills the program for services or treatments that were never actually provided to the patient.

DEFENSE TEAM SPOTLIGHT

Todd Spodek

Lead Attorney & Founder

Featured on Netflix's "Inventing Anna," Todd Spodek brings decades of high-stakes criminal defense experience. His aggressive approach has secured dismissals and acquittals in cases others deemed unwinnable.

NY Bar Admitted Multi-State Licensed Federal Courts

Meet the Full Team

Legal Scenario: What Would You Do?

Scenario

You are a home health aide agency owner in Brooklyn and just received a letter from the New York State Medicaid Fraud Control Unit stating they are investigating your agency for billing Medicaid for patient visits that were never performed. Several of your employees have already been contacted by investigators and asked to provide statements.

What should I do right now to protect myself and my business from these Medicaid fraud allegations?

Attorney's Answer

First and foremost, do not speak with investigators or allow your employees to provide any further statements without legal counsel present — anything said can be used against you in both criminal and civil proceedings. Under New York Social Services Law § 145-b and Penal Law § 177.25, Medicaid fraud charges can range from misdemeanors to Class B felonies depending on the dollar amount involved, carrying penalties of up to 25 years in prison. Our team will immediately review your billing records, employee documentation, and any correspondence from the Medicaid Fraud Control Unit to identify weaknesses in the government's case and explore whether any discrepancies were the result of clerical errors rather than intentional fraud. We may also negotiate with prosecutors under the New York False Claims Act to pursue a civil resolution rather than criminal charges, potentially saving your license and your freedom.

This is general information only. Contact us for advice specific to your situation.

Upcoding or Unbundling

Upcoding involves billing for a more expensive service than the one actually provided, while unbundling refers to billing for individual components of a service instead of the bundled rate, resulting in higher reimbursement.

Kickbacks and Referral Schemes