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Medicaid Fraud Investigation

March 21, 2024 Uncategorized

In today’s world, it’s harder and harder to keep up with the ever-changing rules when it comes to government programs. With the introduction of the Affordable Care Act, better known as Obamacare, the rules when it comes to Medicaid have become even more complex than before. As a result, more cases of Medicaid fraud are being brought against unsuspecting persons than in years past. Being charged with Medicaid fraud can be not only stressful and time-consuming when trying to prove one’s innocence, but if convicted the penalties can be devastating. Large fines, loss of professional licenses and even years in prison can await those convicted of this crime. To make sure this does not happen, there are many things to be aware of when it comes to Medicaid fraud.

The Basics of Medicaid Fraud
Because Medicaid is a medical coverage program run jointly between state and federal governments, a topic of much discussion involves lowering budgets in order to let the government save money when providing coverage to those who cannot afford it themselves. One of the main ways governments looks to decrease costs is by eliminating fraud. However, in doing so they often accuse people who have no intention of defrauding the government. In fact, many fraud investigations begin by an investigator speaking with a person’s friends, neighbors and even co-workers to obtain information regarding their benefits and activities.

Going from Bad to Worse
Once an investigation is begun, the situation can quickly escalate far beyond what may be expected. A fraud suspect usually receives a letter from the investigator, stating the nature of the investigation and asking them to produce certain documents to answer the accusations. In most cases, a face-to-face interview is also requested. Before speaking with the investigator, it’s vital to keep in mind that person already believes you are guilty. The accusations can come from a number of things, such as being suspected of reselling medications purchased through Medicaid, forging documents to receive extra benefits, letting others use a Medicaid card or other crimes.

Meeting with the Investigator
When it’s time to meet with the fraud investigator, having an attorney come with you is not only your right, but also a very smart thing to do to ensure the meeting is conducted in a fair and professional manner. Much like a police interrogation, anything an accused person says during the course of the interview can be used against them in court. What makes these meetings so perilous is that one innocent mistake, such as a rule that has been construed incorrectly, can result in criminal charges being filed. This is when having an attorney represent you can sometimes make a tremendous difference in the outcome of the investigation, and can many times result in any charges being dropped or a compromise being reached.

The Rights of the Accused
When people are accused of Medicaid fraud, one of their first fears is the thought than their benefits will be cancelled or withheld pending the outcome of the investigation. However, that is not the case. Anyone accused of Medicaid fraud has the right to answer all or none of the questions posed to them, and they also have the right to have an experienced Medicaid attorney present to advise them during the process. Most attorneys agree the best strategy is to cooperate with investigators, but there are times when an investigator may handle an interview inappropriately by making improper requests for documents of making unfounded accusations against the accused.

What Can Result from an Investigation?
For people who are found guilty of Medicaid fraud, many punishments are possible. In some cases, benefits may have to be repaid. This can be done through wage garnishment or civil judgments and liens against a person’s home, and in some cases professional licenses may be revoked. In extreme cases, deportation can result if a person’s immigration status is found to be in violation of federal laws. In some instances, the amount of fraud may be too small for criminal prosecution, yet it still needs to be dealt with. In these situations, an Administrative Disqualification Hearing may be held. These hearings seek to determine if fraud was intentionally committed and if the benefits should be suspended for a period of time or eliminated altogether.

For anyone who is accused of Medicaid fraud, the best course of action is to immediately hire an attorney experienced in this area of law. Legal situations involving the federal government are always complex, so attempting to go it alone or with someone with little if any experience in these matters is not a wise move to make. Whether innocent or guilty of Medicaid fraud, having an attorney who can offer sound advice can help lessen any penalties given or be the deciding factor in proving one’s innocence.

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