27 Jul 23

Brooklyn Medicaid Fraud Lawyer

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Last Updated on: 24th August 2023, 01:01 am

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.

Don’t deal with Brooklyn Medicaid Fraud Lawyer alone. Speak to the Spodek Law Group today.

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

Medicaid fraud falls into four key categories. There is the medical billing fraud, unnecessary services, upcoding and unbundling. Medical billing fraud occurs when the medical facility provides bills for services not performed at the facility. It also involves cases where the facility continues to bill for services rendered even after the patient has been discharged or died. Frauds linked to unnecessary services involve cases where a provider falsifies diagnostic results and symptoms on a patient’s records and bills them to obtain payments.

Upcoding involves billing for Medicaid services using complex system codes. In this case, the offender is committing a fraud by billing for a more expensive procedure. Unbundling involves separating a group of procedures that have a special reimbursement rate. In this case, the provider unbundles them and bills them separately to get more money.

Possible Penalties for Medicaid Fraud in Brooklyn

The penalties for Medicaid fraud can be severe. The penalties range from jail terms to fines, probation and restitution. Jail terms can be anywhere from five years to life imprisonment. The terms depend on the scale of fraud and whether it leads to physical injury or death of the patient. Fines may range from thousands to hundreds of thousands of dollars.

In some cases, offenders may be put on probation. During probation, they are required to meet all probationary requirements, including regular attendance, employment standards and more. If the fraud resulted in loss of funds for the patient or insurance company, the offender may be ordered by the judges to reimburse the parties affected for the money lost.

Surviving a Medicaid Fraud Investigation

When you are suspected of committing a Medicaid fraud, you will receive a letter from the Bureau of Fraud Investigation. The letter contains all the details related to the fraud. It may also ask you to turn over documents and schedule a meeting with an investigator for an interview. By the time you meet him or her, the investigator has already gathered all the evidence he needs to pin you down.

There are ways you can survive medicaid fraud investigations. You can prove that the allegations have no basis by telling the investigators that you are one of those people who were flagged without committing any offense. If the investigators still insist on pushing on with the case, you can examine their evidence and look for faults. You can then show them these faults and convince them that the district attorney will not take their case.

You can also starve the investigators of information. By not giving them all the information they need, you will be making it difficult for them to file strong case against you. But be very careful with this technique. If the investigator discovers that you knowingly denied them information, they can press more charges.

Hire a Lawyer

Do not try to handle a Medicaid fraud investigation on your own. Any wrong move or misplaced priority can give the investigators the opportunity to file criminal charges against you. You need to contact an experienced Medicaid fraud lawyer before you even respond to the letter from the Bureau of Fraud Investigation. A Medicaid lawyer will protect your rights, prepare your defense and explore all options to ensure the investigators do not file criminal charges.

Do not take chances when you are facing Medicaid fraud charges. Take all the necessary precautions to protect yourself.