Bronx Medicaid Fraud Lawyer

Due to public debate surrounding federal health-care policy, Medicaid fraud has increasingly become a popular topic of discussion in New York and around the country. While it is not uncommon for people to suspect working class and low-income populations are the main culprit of Medicaid fraud, the truth is most instances of fraud are committed by organized crime rings and sometimes by healthcare workers and facilities. For Those who commit Health Care fraud, it is very tempting to believe it is easy to get away with the crime. However, the risk exceeds the reward because Medicaid fraud is considered both a state and a federal offense, and conviction may result in the perpetrator spending decades in prison and being required toupee tens of thousands up to hundreds of thousands of dollars in fines depending on the scope of the fraud. Therefore, no one who is under investigation for Medicaid fraud or who has been charged with a Medicaid fraud offense should take the situation lately. A bronx Medicaid fraud defense lawyer can help individuals who are under investigation as well as those who have been formally charged.

Medicaid Fraud in the bronx

There are multiple ways in which Medicaid fraud may take place. Generally, under New York state law, the prosecution must prove the following before a defendant may be convicted of Medicaid fraud:

• The defendant knowingly transferred or delivered a prescription or medical device in exchange for anything of pecuniary value well being aware that the recipient had no medical need for the prescription or device.
• The defendant received, in exchange for anything of pecuniary value, a prescription medication or medical device despite knowing or having had reason to know the defendant was not authorized to sell or distribute the prescription medicine or device.
• The defendant transferred a prescription medicine in exchange for anything of pecuniary value.
• The defendant received a prescription medicine in exchange for anything of Pekin area value.

New York law defiance the term medical device as any item for which a prescription is required to sell, deliver, or transfer the item. Therefore, an individual may be convicted of Medicaid fraud if he or she illegally exchanges a prescription drug or even an item that would be otherwise identified as a medical device.

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Todd Spodek

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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.

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Legal Scenario: What Would You Do?

Scenario

You are a home health aide in the Bronx who discovered that your employer has been billing Medicaid for patient visits that never occurred, and your name appears on the falsified service logs. Now you've received a letter from the New York State Medicaid Fraud Control Unit requesting an interview about the billing discrepancies.

Can I be held personally liable for my employer's fraudulent Medicaid billing even though I had no knowledge of the scheme?

Attorney's Answer

Under New York Penal Law §177.05 through §177.25, Medicaid fraud charges range from misdemeanors to Class B felonies depending on the dollar amount involved, and prosecutors must prove you knowingly participated in the fraudulent scheme. However, the fact that your name appears on falsified records makes you a target, and anything you say during that interview can be used to build a case against you. You should not speak with investigators from the Medicaid Fraud Control Unit or the Office of the Medicaid Inspector General without an experienced defense attorney present. Early intervention by counsel can often prevent charges from being filed by demonstrating you were an unwitting participant rather than a co-conspirator in the billing fraud.

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

Detecting Medicaid Fraud