12 Dec 19

NYC Medicaid Fraud Lawyers

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Last Updated on: 29th August 2023, 06:41 pm

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 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.

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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 best 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, 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.

NYC Medicaid Fraud Lawyers

Medicaid has been gaining a lot of attention lately due to the intense debates over healthcare coverage and how to make sure that as many people as possible have access to affordable health insurance. This is a state and federal program that helps cover the cost of healthcare for those who do not earn enough income to pay for it completely by themselves. There is always intense scrutiny over procedures and bills involving Medicaid because there is a lot of potential for providers and billers to defraud the system, which passes costs along to taxpayers. Governments have a strong incentive to actively police the Medicaid programs so that they can demonstrate to taxpayers that they are being as vigilant as possible in preventing fraud throughout the system.

Even if you have not done anything intentionally wrong, there are many ways in which you or your company could be involved in Medicaid fraud allegations because of all of the complexities of the system. A simple billing error involving an incorrectly coded medical procedure or service could open the floodgates to a full investigation into your office’s practices in treating and billing patients. The government is also on high alert for fraudulent practices involving prescriptions, especially when pain killers are involved. The improper issuance of prescriptions for patients who are not actually in need of prescription pain killers can invite serious fraud investigations by the government.

One of the ways that many Medicaid fraud investigations by the government are initiated is through internal reporting from employees, such as whistleblowers. Employees may speak directly with government officials regarding instances that they perceive are fraudulent. It is beneficial to discuss with an attorney what your internal reporting procedures are for mistakes or intentional fraud by employees within your company or practice so that you are aware of these issues immediately. It is helpful to have the advice of someone outside your company to help craft these policies so that you are complying with all of your obligations and do not jeopardize your professional license.

The penalties for being convicted of Medicaid fraud can be severe. They include expensive fines and even potentially prison time. You could also lose your ability to practice and may have to give up your license. Before you face any of these upsetting possibilities on your own, you should involve a trusted lawyer as soon as possible in the process. Gathering documents and important testimony to prove your case is essential and requires the assistance of an advocate who regularly assists other professionals and companies with New York Medicaid fraud investigations. This is not the time to take chances with something that could end all that you have worked for.

Contact the Spodek Law Group Today

If you find yourself involved with a Medicaid fraud matter, it is best to seek out experienced counsel to help you navigate this complicated process. Call the seasoned legal team at the Spodek Law Group right away to get the representation you need to protect your career, reputation and livelihood. Medicaid fraud investigations are serious matters that require in-depth knowledge of the process to successfully defend yourself in these situations. Call the Spodek Law Group right away at 800-409-0215 to schedule an initial consultation with one of our New York City Medicaid fraud lawyers as soon as possible. Take the first step in getting your Medicaid fraud investigation issue on the right track to resolution.

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NYC Medicaid Fraud Lawyers

Medicaid fraud occurs when services are billed for even though they were not provided; when tests that are not necessary are performed and then billed for; when unnecessary referrals are made to a patient; or when services that should be bundled together for a lower rate are charged separately. If you have a letter from the NYC HRA that says your Medicaid eligibility is under review, it’s possible that you’re being investigated for fraud. Contact a New York Medicaid fraud attorney right away.

Receiving an HRA Letter

If you have received an HRA letter, that usually means that the investigation is open and the investigator believes you’ve committed Medicaid fraud. The letter may say that you have to meet the investigator at a specific date and time. It’s best to go to this meeting with an attorney instead of showing up alone. By the time the investigator wants to setup a meeting, they’ve already gathered evidence against you. If you don’t have an attorney to advise you, you could end up saying something that only makes the investigator’s case stronger.

You have a legal right to meeting with a Medicaid fraud attorney or retaining the attorney’s services prior to your meeting with the investigator. You do not have to answer any of the investigator’s questions, whether or not you have an attorney present, and can stay silent if you wish.

Investigation Into Medicaid Fraud

There are several ways that an investigator may gather evidence to support a Medicaid fraud case. First, they review your applications for food stamps, public assistance and Medicaid programs. They can also access information from databases like NYS Real Estate, DMV, and NYS Division of Corporations. They may go to your neighbors and ask to speak with them in order to verify your address. They may even contact your employer to find out how much you earn.

Note that the District Attorney’s office isn’t the only agency that may conduct an investigation into Medicaid fraud. The Bureau of Fraud Investigation, the NYS Office of the Welfare Inspector General or the IREA may look into Medicaid fraud, too. These agencies, along with others, often look into individuals or groups who may be committing Medicaid fraud.

Reasons for a Medicaid Fraud Case

There are several reasons why a person who received Medicaid may be investigated. Often, this happens because the Medicaid recipient doesn’t put down their full income on the Medicaid application, or they do not tell the agency when their household income increases. It’s necessary to disclose the following information:

• Your actual earned income
• The actual earned income of those you live with
• The income of anyone you have a child with
• Unearned income, which includes gifts, rental income or other types of support
• Changes in address or number of household members

Even if a Medicaid enrollment agent completed your application for you and they told you it was ready to send in, you’re still responsible for the information on that application. Signing your name means you agree with the information on the form, and if the information is incomplete, you could be convicted of perjury. The enrollment agent is not responsible for supplying correct information on the application.

When you’re investigated for fraud, there are several consequences you face, including fines and criminal charges. If you’re not a U.S. citizen, you may be facing removal or deportation. As soon as you receive a letter from the HRA, contact an experienced attorney, who may be able to find a solution for the case before it proceeds to the DA.

criminal Proceedings

It’s not uncommon for people to face criminal charges if they were investigated for Medicaid fraud. You may be arrested and asked to stay in jail until you’re able to see a judge, which can take upwards of 24 hours. You may be facing criminal charges like possession of stolen property, welfare fraud, felony or grand larceny.

Even if the District Attorney’s office has already contacted you regarding your criminal charges, it’s still possible to negotiate a lighter sentence or avoid incarceration completely. An experienced Medicaid fraud attorney will negotiate on your behalf in order to get the best settlement possible.

Consequences of Medicaid Fraud

criminal consequences of Medicaid fraud include time in prison, losing professional licenses or deportation. Even if you are not facing criminal charges, there are other consequences that you should know about. You may have to pay for the healthcare you or your family received when you were not actually eligible for Medicaid benefits, and these monetary charges may include interest. It’s also possible that a lien will be placed against your property or that your paychecks will be garnished.

If you’re the victim of a Medicaid fraud case, contact our New York Medicaid fraud attorneys today.