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Bronx Medicaid Fraud Lawyers

The Importance of Legal Representation in Medicaid Fraud Cases

Every interaction that you have with the legal system should almost certainly come with at least the advice of a lawyer, if not a full-time legal advisor. This is particularly true when it comes to criminal charges because of the possible outcomes as well as the complexity of the legal process. When it comes to Medicaid fraud, that is even more true. Medicaid fraud can be tricky to untangle and in court, it is harder to defend yourself simply because of how technical the details can be. Our firm has years of experience working in Medicaid fraud defense, and we understand what it takes to help you work through the system and come out with a better outcome.

What is Medicaid Fraud?

Medicaid fraud is a broad term. Many crimes have specific and constrained legal definitions, but Medicaid fraud simply includes any act that attempts to extract extra money from the Medicaid program. The person accused of Medicaid fraud has to be some form of care provider, such as a doctor, but can include any individual professional or company that interacts with Medicaid and bills it for services. There are several different forms that this type of fraud can take. For example:

  • Upcoding: A service provider could upcode their service on their bill. This means upgrading a service to look like something more expensive than what it actually was. For example, a doctor could upcode a routine office visit to also include an expensive test that he never performed. Medicaid would then compensate him for this test and he could pocket the money.
  • Billing for Non-Performed Services: A service provider could also bill for services that they just never performed at all.

The common theme is that the service provider lies on their bill in order to extract extra money from Medicaid.

Penalties for Medicaid Fraud

The penalties for Medicaid fraud depend on the size of the fraud. They will always include a requirement that the service provider pay back all of the funds they took, plus an additional penalty that is up to the court to determine. The jail time includes up to five years per instance of fraud. As you can see, the penalties can range from relatively minor to very severe, and much of it is under the control of the judge, so it is hard to predict exactly what the sentence of any individual case will be.

Should you stand accused of Medicaid fraud, then, it is absolutely imperative that you have an experienced and qualified lawyer supporting you and advocating for your interests. The penalties can grow large, so reducing them or getting the charges dropped entirely can make a big difference. It can mean many thousands of dollars and years in prison if you have a competent legal staff working for you.

Strategies for Defending Against Medicaid Fraud Charges

The strategies for defending against Medicaid fraud charges are varied. One aspect is the nature of the evidence. It may or may not be enough to demonstrate that fraudulent charges actually took place. Having evidence of a service existing on a bill is one thing, and that is generally not difficult to find. What is significantly harder is proving that the service did not take place and that the charge was fraudulent.

Because you are innocent until proven guilty, the prosecution must demonstrate that the bill was falsified with the intention of taking money from the program. A successful defense involves finding holes in the prosecutor’s chain of reasoning or problems with their evidence. It is also important to note that plea bargains are an important and accepted part of legal defense. It might feel uncomfortable to take a plea bargain, but they often lead to significantly lighter sentences as well as much lower legal fees. In many cases, the government does not initiate a case and bring charges of Medicaid fraud until they are already confident that they have assembled enough evidence to convict. Under those circumstances, a plea bargain is the best choice because the odds of an outright victory at trial are low.

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