Brooklyn Medicaid Fraud Lawyer

Medicaid is an important federal program. This program is intended to make sure that all people who need it get access to basic medical care as well as more advanced procedures such as surgery. People who fall into certain categories can apply to be covered by Medicaid. Providers across the country are entrusted with making sure that all those who qualify receive the best possible care. Both users and those providing care need to follow certain guidelines.

Users need to make sure they have filled out the application accurately. Those who provide services must observe all guidelines and charge only what is allowed under the program. Medicaid recipients and those who provide such care who do not follow the guidelines and deliberately violate them in some way can be charged with what is known as Medicaid fraud. As Medicaid is a taxpayer provided system, the taxpayers have a vested interest in making sure that all funds used are used as set forth by the agency. Fraud costs the taxpayer literally billions each year. Officials are doing their best to crack down on it.

Multiple Forms of Medicaid Fraud

Home to over a million people, Brooklyn is also home to many Medicaid users and providers. Those who participate in this system may be violating Medicaid guidelines accidentally. However, some providers may be deliberately engaging in Medicaid fraud. There are many forms of possible Medicaid fraud. Over the years, officials have discovered certain patterns of behavior.

For example, a patient can be charged twice for the same services. This is not allowed under guidelines. It is known as double billing. Some providers can go so far as submitting bills for workers who are not actually working. For example, they may file records for a physical therapist or a lactation consultant. However, this person is not actually at the facility nor are they engaging in any form of patient care. Sometimes, a patient may come to a facility for a minor issue such as a sore knee or back pain. Rather than prescribing basic procedures that are known to be cheap and effective, the facility owner may fraudulently choose to proscribe a course of treatment that is far more expensive merely in order to bill Medicaid for these procedures.

In many instances, providers are accused of providing services that were unnecessary for the patient’s well being. A single employee may be accused of engaging in Medicaid fraud or the entire practice may be charged. Anyone facing such allegations should take them very seriously. A conviction can lead to the practitioner being unable to accept Medicaid patients or even having their license revoked by the state of New York. They can also face the possibility of heavy fines and even jail time.

Many neighborhoods in New York have a relatively large percentage of the population reliant on this form of aid to pay their bills. As such, providers who are not allowed to accept Medicaid payments may be at a distinct disadvantage compared to others in the area. This is why is imperative to fight such charges. Gathering evidence and mustering a defense may be sufficient to lead officials to drop the investigation. They can also help clear an employee’s name if they made a minor and entirely accidental mistake.

All possible cases of Medicare fraud must be substantiated in order for the accusation to stick. This means that officials must be able to prove that the fraud was done intentionally and not as part of a mistake. Someone billing the wrong amount merely because they entered the wrong number is a file is not someone who can be charged with engaging in Medicaid fraud. The same is true of a professional who honestly believes they acted correctly when diagnosing a problem and starting on a course of treatment. This is why it is crucial to be aware of all aspects of Medicaid guidelines and follow them to the letter. Employees must be trained to be careful about all they when working with this program. If something goes wrong, hiring a lawyer can help clear up the matter. It can also protect that provider’s business and their overall reputation in the community.

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Legal Scenario: What Would You Do?

Scenario

You are a healthcare provider in Brooklyn who recently received a letter from the New York State Office of the Medicaid Inspector General stating that your billing records are under investigation for suspected upcoding and billing for services not rendered. Federal agents have also contacted your office manager requesting patient files and billing documentation.

What should I do immediately to protect myself and my medical practice from these Medicaid fraud allegations?

Attorney's Answer

You should not speak with investigators or turn over any documents without first consulting a Medicaid fraud defense attorney, as anything you say or provide can be used against you in both criminal and civil proceedings. Medicaid fraud in New York can be prosecuted under both state law (New York Social Services Law §145-b and Penal Law §177) and federal law (18 U.S.C. §1347), carrying penalties that include prison time, heavy fines, and exclusion from all federal healthcare programs. An experienced Brooklyn Medicaid fraud lawyer can intervene early to negotiate with the Medicaid Inspector General's office, challenge the audit methodology, and potentially resolve the matter before criminal charges are filed. Time is critical because early legal intervention can sometimes prevent an investigation from escalating to a grand jury indictment.

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

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