Medicaid Fraud Lawyers
It can begin when a Medicaid fraud investigator obtains information about a person’s benefits. This information may indicate a person is not qualified for the Medicaid benefits they are receiving or worse. Many times this information is obtained from a variety of records. This includes property records, business records, payroll records and more. A Medicaid fraud investigator may even obtain information about a person from their co-workers or even people living in their neighborhood.
Notification
A person will usually learn they are the subject of a Medicaid fraud investigation after receiving a letter from an investigator. The letter will usually ask the person to produce a number of documents. The investigator will then want to meet with the person for an interview.
Accusations
There are a number of reasons a person may be investigated for Medicaid fraud. The investigator could suspect a person did not tell the truth on their application. This could include information about their income, assets and more. Some people are suspected of reselling the medicine or other products they received through the Medicaid program. Others are accused of forging, altering or receiving duplicated prescriptions. Others may have obtained services they are not eligible to receive. In some cases, people are accused of letting another person use their Medicaid card. There are individuals who are accused of having and using more than one Medicaid card.
Meeting
It’s important that people realize when they get this letter, the investigator has already collected evidence against them. The Medicaid fraud investigator believes the person has broken the law. Anything a person says during their meeting can be used against them in the future. An innocent mistake could result in a person having criminal charges filed against them. People have a right to have an attorney with them during this meeting. An experienced Medicaid fraud attorney should be consulted before anything is said to the Medicaid investigator, or any documents are provided.
Rights
A person has the right to have an attorney present when they meet or speak with the Medicaid fraud investigator. An individual does not have to answer the investigators questions. It is within their rights to say nothing. A person who is being investigated and receives benefits from the Family Health Plus or Medicaid won’t have their benefits canceled simply because they refuse to answer an investigators questions. How a person is advised to approach the situation will depend on the facts of their individual case. An appropriate question, as well as document request, will be addressed. The investigator could also ask questions and have document requests that are improper. In some situations, the best way to handle the situation is to cooperate with the investigator. An experienced attorney will know how to negotiate the best possible result. The goal will always be to protect an individuals rights.
Possible Penalties and Punishments
When a person is guilty of Medicaid fraud, there are a variety of punishments they could receive. A person may have to repay Medicaid for the benefits they received and in some cases, individuals will go to prison. People have also been excluded and disqualified from receiving any Medicaid benefits in the future. Some people have even received civil judgments as well as liens on any real property they own. It’s possible a person’s wages could be garnished or their professional license suspended or terminated. Depending on a person’s immigration status, they could even be deported.
Administrative Disqualification Hearing
In some situations, the government may believe a person has intentionally defrauded Medicaid, but their fraud does not rise to the level of criminal prosecution. The reason for this is the amount of fraud is too small. The case may then be referred to the Office of Administrative Hearings (OAH). This is part of the New York State Department of Social Services (NYSDSS). This is where an administrative disqualification hearing will take place. The purpose of the hearing is to decide if a person intentionally defrauded Medicaid and if they should be disqualified from getting benefits for a period of time or never again.
Hire An Attorney
An experienced lawyer will know what needs to be done in a Medicaid fraud allegation case. If a case isn’t able to be defended, a knowledgeable attorney will know how to reduce a person’s criminal exposure. A lawyer will know how to assemble all of the important information to get their client the best possible outcome. They will know how to work with a specific judge or prosecutor. Most individuals who are prosecuted with Medicaid fraud in a New York court are charged with a felony. A guilty plea will result in a person having a criminal record. An attorney will know how to negotiate with a DA or Judge to have their client plead to a reduced Misdemeanor charge. In some situations, they can also negotiate a plea bargain. This will enable a person to avoid a criminal conviction, as well as a criminal record.
Who Is Likely To Be Targeted For Medicaid Fraud
Medicaid fraud is a serious problem. It costs the Medicaid program more than $30 billion a year. Medicaid fraud takes many forms. It includes:
1. Billing for services not rendered
2. Billing twice for the same medicine
3. Billing for a more costly service than was performed
4. Performing and billing for unnecessary procedures
5. Billing for two separate services when they were actually combined into one
6. Billing Medicaid for brand name drugs and dispensing generics.
This type of fraud is often committed by dentists, physicians, and mental health professionals. Sadly, some home health care agencies, hospitals, medical clinics, medical equipment companies, medical equipment companies, medical transportation companies, nursing homes, pharmaceutical manufacturers, and pharmacies have also been found guilty of Medicaid fraud.
Anyone who uses Medicaid could be victimized by people committing Medicaid fraud. Unfortunately it is people who are the most vulnerable that medical professionals and institutions target. While Medicaid fraud impacts every tax payer as they are the ones that ultimately pay for them program, unscrupulous institutions and medical professionals tend to focus their nefarious schemes and scams on people within certain groups and victimize them. The following groups tend to be the most common victims.
•Elderly Patients Over 60 Years Old
Many elderly patients rely on Medicaid as their primary form of medical insurance. Often people in this group are unfamiliar with the intricacies and nuances of the Medicaid system and are forced to rely on medical professionals and health care institutions to help them with the paper work. This makes it much easier to defraud them without their knowledge.
•Nursing Home Patients
Nursing home patients are often very old and extremely ill. Plus they tend to stay at the facilities a very long time. This gives a number of people who work there easy and repeated access to their Medicaid documents. These patients also receive many different types of treatments which are paid for by Medicaid. Unless they have loved ones who visit them consistently and pay close attention to their treatment record and Medicaid payment history, they can become unsuspecting victims of Medicaid fraud.
•Mentally Ill Patients
For medical professionals and facilities looking to commit fraud, the mentally ill make the perfect victims. They require lots of treatment. They stay in treatment facilities for extended periods of time. Their mental state makes them unable to monitor, sign for, or even know what type or how much treatment they receive. Unless they have someone who is paying close attention to their treatment regimen and what Medicaid is being asked to pay, their medical records can easily be doctored and Medicaid billed for services and medications they didn’t receive.
•Home-Bound Patients
Patients that rely on medical professionals to come to them or who must be taken to treatment facilities on a near daily basis can sometimes find themselves defrauded by the medical transportation companies that take them around or the medical professionals who provide them with daily or weekly treatments. Often only the integrity of the majority of people providing them with care and the vigilance of loved ones prevents them from becoming victims of Medicaid fraud.
•Medical Facilities
Medical facilities or treatment centers with lax oversight can also find themselves victims of Medicaid fraud. Patients, medical professional, and people and organizations providing ancillary services can take advantage of the lack of proper oversight to defraud Medicaid in any number of ways. It’s incumbent on all facilities that provide care for patients and handle patients’ medical records to have effective systems in place to protect the records and ensure what they are billed corresponds to the treatment and other services they receive.
Preventing or reporting Medicaid fraud is the responsibility of everyone who has access to the medical records of the person receiving care. The patient is the first line of defense against this type of crime. If possible, they should pay attention to the treatment they are receiving and compare it to their billing records. When the patient is unable to do this themselves, a loved one or social service professional should be assigned this responsibility. This is an important task that must be taken very seriously. Such vigilance also helps prevent patients from being given the wrong treatment or medication.
Many people see Medicaid fraud as a victimless crime. They see the Medicaid system as a large, unfeeling monolith with unlimited funds. In reality, when people defraud Medicaid, they are actually taking money directly out of the pockets of the American people. Medicaid is one of many programs which are largely paid for with tax dollars. When those funds are drained through Medicaid fraud, the government must either raise taxes to cover the shortfall or reduce the amount of services Medicaid provides. Either way it is the American people who must bear the burden.