Healthcare/Medicaid Fraud Lawyer in New York City
Representing Medical Professionals
What is Considered Medicaid Fraud in New York?
A Medicaid fraud accusation is a critical issue yielding dire professional and personal repercussions. As Medicaid continues to serve many United States citizens, the federal government—along with the city of New York—works to maintain the integrity of the program. With strict oversight from multiple layers of government, there are potentially crippling consequences for those accused of Medicaid fraud. Working with a Medicaid Fraud Lawyer in New York City will provide the best chance to defend yourself against unwarranted allegations of Medicaid fraud.
According to New York law, the definition of Medicaid fraud, referred to as Healthcare Fraud, is the action of falsifying information to benefit from reimbursements for medical care beyond the payment for the services provided. Multiple penal codes are in place to penalize healthcare fraud infractions and protect the American public from those who seek to defraud the government. Improper payments due to Medicaid fraud in 2015 alone totaled over $29 billion.
Being accused of abusing the Medicaid system is different from fraud. When accused of fraud, it means that the truth is being misrepresented to benefit from patients. Medicaid abuse means that a practice is being accused of increasing costs above acceptable business parameters. Abuse and fraud are different, but New York City works to detect, report and prevent both in equal measure.
Law Enforcement and Medicaid Fraud in New York City
In New York City, the primary enforcement agency that deals with Medicaid fraud is the office of Attorney General Eric T. Schneiderman. Under the attorney general, the Medicaid Fraud Unit utilizes dozens of investigators, prosecutors, and auditors to handle accusations and Medicaid fraud cases. Federally, the Medicaid and CHIP Payment and Access Commission (MACPAC) provides policies and data analysis for legislature. The Bureau of Fraud Investigation fields complaints on fraud reporting throughout the US.
The government is leading multiple initiatives to prevent increase in Medicaid Fraud. Such tactics taken by the government to lower fraud rates include:
- Data mining
- Risk Analysis
- Enforcement Actions
- Provider and Enrollee Outreach
- Technical Fraud and Abuse Assistance
Governments at the state level also act to ensure that Medicaid fraud is adequately dealt with. States such as New York use three strategies to prevent healthcare fraud:
- Provider Screening
- Prior Authorization
- Post-payment Review and Recovery.
Government Medicaid Prevention
To combat Medicaid fraud, Congress passed the Affordable Care Act, or ACA legislation, to account for several health-related provisions. The ACA works to provide tools to identify, detect, and take legal action against suspicion of healthcare fraud. To focus on useful changes, the ACA:
- Adds Penalties to Medicaid Fraud Crimes
- Increases Budgets for Fraud Investigation and Reduction
- Improves the Fraud Screening Process
- Enhances Data-sharing to Identify Fraud.
Government Integrity Provisions
- Investigation Suspension: If a practice is being credibly investigated, then this leads to a suspension of Medicaid payments.
- Medicaid Claims: Prevents inappropriate payments for claims under Medicaid.
- National Correct Coding Initiative: Processing the coding of Medicaid systems so that practices avoid inappropriate payments.
- Provider Enrollment: Screening any providers before enrollment.
- Provider Participation: Terminating providers if there are records of previous problems from other programs.
- Recovery Audit Contractors (RACs): These contractors audit payments to Medicaid providers. RACs handle overpayment cases and investigate cases of underpayments.
- Home Health: Investigation of home health services shows if a health care provider has met with a patient.
Difference between Medicaid Fraud and Malpractice
Medicaid fraud and abuse differ from malpractice. Malpractice requires that claims be in place against the practice of injuring a patient through medical action. Malpractice may occur during Medicaid fraud; unnecessary procedures medical practitioners use to increase their payments are maleficent in nature to say the least. Legal defense against malpractice follows a different protocol than does healthcare fraud in the court of law and United States legal system.
Individuals Vulnerable to Medicaid Fraud Charges
The list of professionals capable of Medicaid fraud extends particularly to professionals practicing in the medical field. Anyone with the ability to provide and profit from medical assistance is also capable of Medicaid fraud and abuse. Professionals vulnerable to healthcare fraud charges solely based on the nature of their work include:
- Medical Equipment Suppliers
- Medicare Billing Workers
- Victims of Identity Theft.
Identity theft is intricate in that the implications are much greater than the initial crime; the victim is left with an indelible blemish on his or her permanent record that is likely impossible to completely rectify. An identity thief can commit various crimes in the victim’s name. Identity theft in New York City and across the United States is an alarming issue. Considering the crimes someone is able to commit with under the identity of a practitioner with Medicaid access, the potential implications are limitless.
Being the Victim of Medical Identity Theft
Anyone can be the victim of identity fraud. There are multiple ways for a thief to gain a victim’s information and, afterward, the issue becomes a matter of damage control and preventing further problems. There are several government approved steps to defend against identity theft. If there are signs that identity fraud is taking place, appropriate countermeasures include:
- Understanding FCRA Obligations
- Data Security Checks.
Multiple agencies and organizations work to sort through identity fraud cases. Having professionals look into a case is important in a case involving medical identity theft. Medicaid fraud committed by thieves may ruin businesses, which means that professionals must be certain that the allegations against a practice are legitimate.
Agencies Working to Prevent Identity Theft
The federal government is not the only organization working to prevent identity theft in the healthcare industry. Groups, such as the Medical Identity Fraud Alliance (MIFA), work to make sure that cases like yours are not left uninvestigated. By enlisting the help of official fraud prevention organizations, you can strengthen your case in court. You will need an attorney to help sort out the legal aspects of your case and explore all avenues of protection.
Different Types of Medicaid and Healthcare Fraud
Medicaid fraud or healthcare fraud, as discussed throughout, is the act of deceiving patients, insurance companies, or the government and taking advantage of them for financial gain. While deception is at the core of the issue, more specifically the types of medicaid fraud include:
- For Unperformed Services
- Charging for One Service Separately
- Charging Twice for the Same Service
- Dispensing False Drugs
- False Location Claims
- Re-selling Products Obtained Through Medicaid Benefits
- Failing to Disclose:
- Unspecified Services
- Medical Services for Improper Payment
- Providing False Information on Applications or Re-certifications
- Reporting False Costs
- Taking or Giving Bribes
- Ordering Excessive or Inappropriate Tests.
Medicaid fraud laws work to protect patients, as those subject of any of these crimes face irreparable damage to their reputation. Even if a medical professional is the victim of identity theft, the crimes will accrue against them—which is why it is important that individuals facing these circumstances hire an attorney that concentrates in medical fraud law.
Effects of Laws Broken by an Identity Thief
All crimes committed by an identity thief under a victim’s name are then attributed to the victim. The crimes accumulate and victims could find themselves facing an arrest for charges that could ruin one’s medical career. If you even suspect that there may have a been misappropriation by another on any of your privileged medical information, it is impertinent that you consult immediately with an attorney, who focuses on healthcare fraud and identity theft. If identity theft is not handled aggressively, the problem could escalate into a healthcare fraud investigation.
What Happens During a New York Medicaid Fraud Investigation?
Medicaid fraud investigation involves several different groups that become involved in the process. The first obviously being the prosecutors that you will face in court. But before going to court, a New York City based practice will need to face the Office of the Attorney General and the Medicaid Fraud Control Unit. New York City has multiple groups handling both Medicaid prosecution and defense so knowing which do what in an investigation is vital for your legal protection. Knowing who is able to help and what your options are also works in your favor in case of arrest and questioning.
When questioned there are certain guidelines officers must take with the accused. There is a distinct difference between appropriate and improper questions that will need to be legally enforced. During a questioning there will also be a chance for negotiation, which your attorney will handle in order to receive the best result. However, it important to keep in mind that everyone has rights—namely, due process—no matter the Medicaid fraud accusations.
What to Do If Falsely Accused of Healthcare Fraud in NYC
An arrest on false charges means that there are different actions to consider and to take in order to prevent the situation from becoming worse. You very much have the right to remain silent, a phrase out of context or misconstrued statement could make your case much more difficult. On a different note, if you are a Medicaid beneficiary yourself, the investigation should not interfere with the benefits you receive. The most important action you should take is to get in touch with your Medicaid fraud lawyer as soon as possible to handle the charges appropriately.
Past New York City Medicaid Fraud Cases
If you think you are the first to be falsely accused of medicaid fraud—don’t. A doctor’s receptionist was caught forging prescriptions, which led to an investigation of the doctor, as well. There are even cases where non-practitioners pretend to be medical professionals—such as a man, who pleaded guilty to posing as a dentist at a Queens practice. You will need an aggressive legal defense in order to avoid a medicaid fraud conviction. A New York State investigation revealed widespread medicaid fraud—causing supervisory hypervigilance. With so many cases pertaining to fraud and forgery, it is more important than ever to make sure your legal defense represents and advocates on behalf of the legitimacy of your practice.
Why a Healthcare Fraud Lawyer is Imperative
Healthcare fraud entails several legal layers to interpret and understand in order to craft a solid defense against accusations. The legalities are complex; a single mistake could lead to disastrous results for your case–which is why it is recommended that you hire an attorney practiced in this unique niche. The more granular Medicaid laws require expertise in order to best interpret and strategize an aggressive defense. Gaps in your legal defense will leave you susceptible to conviction and the penalties that follow.
Medicaid Fraud Punishments
Medicaid fraud is a considerable issue in New York City, and the punishments match the courts’ push to end the practice entirely. Healthcare fraud may range from a misdemeanor class to felony level crime, and brings with it the accompanying penalties. Medicaid fraud charges may lead to:
- Restitution Orders
- Medicaid Benefit Disqualification or Exclusion
- Civil Judgements
- Wage Garnishment
- License Loss or Suspension
- Criminal Prosecution
- Jail Time
- Prison Time
- Defense and Recovery from False Accusations.
In order to further defend against false accusations of Medicaid fraud there are different ways to plan ahead of time and preemptively create a defense against worst case scenarios. A compliance plan makes sure that a practice is up to government standards and is able to prove identity theft took place in extenuating circumstances. False accusations in New York City may lead to problems with the False Claims Act. The faster you bring your attorney in and construct a defense strategy, the more favorable will be the trajectory of your healthcare fraud defense.
Hire a Healthcare Fraud Law Firm that Serves Clients in New York City and Surrounding Areas
Medicaid fraud accusations are a danger to both your medical career and practice. We work in New York City and surrounding locations to defend you against false Medicaid fraud charges. The law firm has the qualifications and case experience in this unique niche to develop your defense and aggressively advocate on your behalf in court. Call now for a free consultation on your Medicaid fraud case.