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Medicaid fraud costs the State of New York billions of dollars that could otherwise be spent to provide legitimate healthcare services. In addition to wasting billions, Medicaid fraud increases potential harm and risk to patients who undergo unnecessary treatments. In 2016 alone, payment for non-covered procedures or for services that were billed but not actually provided amounted to $29 billion. This is a lot of money that could have been spent on services that add value to millions of Americans.
What is Medicaid Fraud?
Medicaid fraud refers to an attempt to get more payments or benefits than you deserve by knowingly providing false medical statements, concealing material facts or engaging in fraudulent schemes. Classic examples of Medicaid fraud include the following;
• Billing of treatments, services or medical equipment that are not covered by the Medicaid plan.
• Misrepresenting or replacing items that are billed to receive more benefits.
• Performing unnecessary services.
• Incorrect documentation. For instance, supplying frequent visits but billing for something more.
• Forcing a patient to make regular visits to the provider’s office, even when it is obvious additional appointments are not necessary.
• Billing for appointments that never occurred.
• Participating in medical identity theft.
While a majority of Medicaid frauds involve healthcare service providers and insurance companies, there are some cases that are linked to patients. Such cases include falsifying information in order to receive Medicaid payments, giving Medicaid ID to others, faking an order of prescription, deliberately getting duplicate or excessive services and using more than one Medicaid ID number.
The states and federal government have developed various strategies to fight Medicaid fraud in the country. Some of these strategies include technical assistance to help detect fraud, data mining, audits, investigations and enforcement actions. These strategies are designed to ensure that eligibility decisions are made correctly and delivered medical services are necessary and appropriate.
Possible Penalties and Consequences for Medicaid Fraud
If the investigators find you guilty of committing a Medicaid fraud, the jury may impose a wide range of penalties. You may be fined a lot of money or disqualified from receiving further Medicaid benefits. The judges may establish liens on any real estate property you own or garnish your wages. Depending on the circumstances that led to the fraud, the investigators may press for criminal prosecution charges that may lead to a harsh prison sentence or suspension of professional licenses. If you are a foreigner, you may face deportation.
Medicaid fraud is a serious crime that can land you in prison for up to 25 years. You need to brainstorm several defense strategies to avoid such potentially life-changing consequences.
Once the investigators have filed their charges, there are some viable defenses you could find useful. For instance, you can question the credibility and motive of the witnesses based on the facts surrounding the case. You can then file a motion to have the case dismissed or the charges limited. You can also question the procedures the investigators followed to arrive at a conclusion that you committed a Medicaid fraud. Investigators are required to have a permit from the relevant authorities and follow constitutional procedures.
Do not go into a Medicaid fraud investigation alone. Remember, the investigators already have the perception that you are guilty. They will use anything you say or do against you to validate their arguments and convince the judges to rule in their favor. Always hire a lawyer for all the investigations and defense to be on the safer side.
Hiring a Lawyer
You need a lawyer who specializes in Medicaid fraud cases to represent you. Make sure he has a good track record representing individuals with similar cases. Ask him how many cases he has handled and whether they were successful or not.
In addition to a good track record, your lawyer should be aggressive and smart. He must aggressively fight for your rights during criminal proceedings and convince the jury to rule in your favor. He should also have a high level of experience and be licensed by the state’s bar.
In summary, Medicaid fraud is the intentional falsification of information in order receive benefits you don’t deserve. It is a serious offense that can land you in jail for a long time. Hence, you need to hire an experienced and specialized Medicaid attorney to defend you and have the charges dismissed or limited.
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