More recently, a number of states, including New York, have take another look at how Medicaid fraud is policed. States like New York are not increasingly focusing on detecting and preventing fraudulent activities earlier, according to the in which they pay Medicaid claims and then try to recover improper payments, they are increasingly focusing on preventing and detecting fraudulent activities early on. according to the National Conference of State Legislatures. This strategy is expected to result in more aggressive prosecution of individuals alleged to have committed Medicaid fraud, as well as of people who take significant steps towards the commission of this crime.
If you have learned that you are the target of a Medicaid fraud investigation, or if you have been charged with a crime arising out of the Medicaid system, you need to understand your basic legal rights. You also need to have an essential understanding of the law as it relates to a Medicaid fraud case.
Types of Medicaid Fraud
As is the case with other types of criminal fraud, Medicaid fraud comes in a number of derivations. With that said, there are three more common types of Medicaid fraud for which people are prosecuted.
Phantom billing is a type of Medicaid fraud in which a medical provider bills for unnecessary procedures or even for procedures that were never in fact performed. Phantom billing also includes submitting a patient to unnecessary tests or billing for tests that were not performed.
Patient billing scam is that involves both a medical provider and a patient. In this type of fraud, a medical provider submits billings for services not performed with the cooperation of a patient in the scheme. The patient receives a kickback from the fraudulent billing.
Upcoding is the third of the common types of Medicaid fraud. Through upcoding, a patient actually did receive services, care, or treatment. However, in submitting a bill to Medicaid, a medical provider bills for a more expensive procedure.
Potential Penalties for Medicaid Fraud
A variety of factors come into play when it comes to imposing penalties in a case involving Medicaid fraud. The factors that come into play include the extent of the fraud perpetrated by the defendant together with that individual’s criminal history. In some instances, the penalty for Medicaid fraud is lessened if a defendant cooperates with the investigation and pleads in the case, rather than forcing the matter to go to trial.
Penalties upon conviction for Medicaid fraud can include a prison sentence, a monetary fine, and a suspension or permanent removal from participating in the Medicaid program. A person convicted of Medicaid fraud is nearly always going to face disciplinary action from his or her professional licensing authority.
Possible Defenses for Medicaid Fraud
In the final analysis, the key to mounting a strong, effective defense in a Medicaid fraud case is retaining the services of a skilled, experienced NYC Medicaid fraud criminal lawyer. During an initial consultation with legal counsel, a Medicaid fraud defense attorney will discuss possible defenses with you.
Potential defense in this type of case can include lack of intent. In other words, while there were misstatements in Medicaid billing, they were the result of a mistake and not an intentional criminal act.
Another defense to a charge of Medicaid fraud is that the defendant was not the perpetrator of the crime. The defense focuses on a contention that while inappropriate or fraudulent billing may have occurred, the person charged was not the individual responsible for the inappropriate bills.
A constitutional defense might also be raised in a Medicaid fraud case. A contention could be made that the investigators violated the Fourth Amendment protection prohibiting unreasonable search and seizure.
The possibility also exists that a capable criminal defense attorney might be able to raise some mitigating factors in a case. Although not a complete defense, a mitigating factor might work to reduce a defendant’s level of culpability in a Medicaid fraud case, which could lower the penalty imposed in a case.
Retain an NYC Medicaid Fraud Criminal Lawyer
The first step in retaining an NYC Medicaid fraud criminal lawyer is scheduling an initial consultation. During an initial consultation, an attorney will provide an evaluation of your case. This will include a discussion of possible defenses. There typically is no fee charged for an initial consultation.
