Last Updated on: 28th July 2023, 07:22 pm

With the health care reform that’s been passed in the last several years, the prevalence of Medicare fraud has increased. These increases have been seen from both patients and health care providers. State and federal governments have started to take steps to crack down harder than ever before on these violations in an effort to reduce their expenditures. Unfortunately, this renewed diligence against fraud has led to cases against many individuals and doctors who have never had any intent of gaming the system.

If you’ve come under investigation for Medicare fraud in New York, you may find yourself facing serious state or federal charges. The following provides some valuable information about Medicare fraud cases, but your first step should be to contact an experienced, proven lawyer to guide you through the legal process.

Triggers for Medicare Fraud Investigations

While some Medicare fraud investigations are launched as a result of direct reports of abuse, many more are the result of reports generated by computer databases that look for indications of abuse. One of the most common forms of Medicare abuse is unreported income, and investigators can compare the income reported on applications with the income reported to other government agencies by employers. Another common red flag for Medicare fraud is a household income that can’t possibly cover expenses. Medical professionals may also be subject to a Medicare fraud investigation if they report rendering services that are out of line with similar providers.

Receiving a letter from an investigator is often the first indication that a Medicare investigation has been opened. This letter includes details about the suspected abuse, and it often requests documentation to counter the accusations. It’s important to keep in mind that the investigator likely already has documentation that supports their belief that fraud has been committed, including details that you may never have provided. In most cases, they’re looking for confirmation of what they already suspect, and any statement you make may be used against you. You’re not under an obligation to answer the investigator’s questions and doing so may be a mistake. A Medicare fraud attorney can advise you on what steps to take following receipt of this letter.

Potential Consequences of Medicare Fraud Investigations

If you’re found guilty of Medicare fraud, there’s a range of penalties from the repayment of expenses to criminal charges. When the government files a civil suit to recover the money that was paid on your behalf, they may obtain a judgment that allows them to file liens against your property or potentially even garnish your wages. Since the costs of health care are rising, you may be required to repay thousands of dollars in medical expenses that you thought were covered by Medicare.

In some cases, the government seeks criminal charges instead of civil action. Charges can include welfare fraud and grand larceny. If you’re convicted, you may face time in jail, fines and a permanent criminal record. Individuals who hold professional licenses, including physicians, may be subject to disciplinary proceedings related to the charges.

The consequences of Medicare fraud are very serious. Even if you never intended to do anything wrong, your circumstances may lead investigators to believe otherwise. The best way to clear up this misunderstanding is to hire an experienced law firm that specializes in Medicare cases to defend you.

Choosing a Medicare Fraud Lawyer in NYC

After you’ve received notification that you’re being investigated for Medicare fraud, your first step should be finding a lawyer to help you work through the situation. An experienced lawyer can advise you on whether or how to respond to investigators’ queries and what to do if the case advances to civil or criminal proceedings.

The choice of a lawyer should be considered carefully. Not all firms are equally experienced with health care law, and Medicare fraud cases can be particularly complex. An ideal law firm is experienced and specialized, and they’ll be willing to provide you with an immediate consultation.

Experience

The best defense lawyers are the same people who used to work as prosecutors for the state. They have experience with the kinds of cases the state is likely to build, including the tricks that they’ll use to gather information. These lawyers will also understand the severity of the charges you’re facing. You’re much less likely to be surprised when your defense team has experience playing for the other side.

In addition to experience prosecuting Medicare fraud cases, look for a firm with an established reputation and a track record of successful outcomes for their clients.

Specialization

There are many facets to health care legal practice, and Medicare is only one of them. When you’re searching for a firm to handle your case, make sure that they have experience with Medicare fraud specifically. An attorney who only has experience defending clients in malpractice or wrongful death proceedings is a bad choice for your case. Don’t settle for an attorney without Medicare experience, even if the rate is tempting. There’s simply too much on the line.

An Immediate Consultation

Time can be extremely important in Medicare fraud cases. Contacting an attorney right away to discuss your options is essential. Many law firms that deal with Medicare cases will offer a free consultation to assess whether they can help you. Take advantage of this as soon as possible to make sure you have the maximum amount of time to prepare your defense.