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We are an elite criminal defense law firm, that emphasizes providing the best service and professionalism to all clients. We service a curated clientele nationwide – that expect the best from their lawyer. We handle tough criminal defense and legal situations that require deep knowledge, experience, dedication, and excellence in order to win. We have over 50 years of combined experience, handling national and international cases.

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Top Rated Attorneys

The Spodek Law Group is one of the most successful law firms in the USA. Our success comes from the fact we are attentive to details, and take a very pragmatic approach to each and every single case. Our clients turn to us for realistic advice – so they can make the appropriate decisions they need to make personally. Our goal is to make sure your case ends in a positive outcome, not only personally – but for your family as well.


New York Medicaid Exclusion Attorney

New York Medicaid Exclusion Attorney

Our New York Medicaid and Medicare exclusion attorneys represent healthcare providers that have been excluded from participation in state and federal program such as Medicaid and Medicare as the result of criminal conviction, a disciplinary action, or an audit.

Although a person is innocent until proven guilty, unfortunately some agencies such as the Office of Medicaid Inspector General (OMIG) and the Department of Health take a different view. These agencies are empowered to safeguard the Medicaid program from potential fraud and abuse and they often take summary actions against providers if they believe that the provider’s further participation in the program is “unsafe”.

If you are a healthcare medicaid provider and are charged with a crime that relates to the practice of medicine or another healthcare area, the Office of Medicaid Inspector General Medicaid will automatically suspend you from participating in the Medicaid program. This means that you will not be permitted to provide any services for which Medicaid is billed, which effectively eliminates most potential employments. It doesn’t even matter to them that you have not pleaded guilty and have not been found guilty and that you are presumed innocent until proven guilty. The regulations give the OMIG clear authority to exclude you just based on the fact of arrest.

What are the grounds for Medicaid Exclusion in New York

In New York, the there are a number of grounds a healthcare provider may be excluded from the Medicaid program. Combined, they are called “unacceptable practices”, which includes just about any conduct the OMIG or the Department of Social Services consider “unacceptable”

There are the common examples of unacceptable practices, which can result in Medicaid exclusion:

  • Making fraudulent claims for services never provided or overbilling
  • Ordering providing services that are not medically necessary or otherwise improper.
  • Practicing a profession fraudulently
  • Practicing beyond the scope of profession
  • Practicing with license suspended or revoked
  • Making claims for services provided by unauthorized personnel (including unlicensed individuals or those excluded from Medicaid)
  • Failing to maintain or disclose record during an audit
  • Kickback violations
  • Being arrested or convicted for certain crimes

Medicaid Exclusion Process in New York

If the government believes that a provider has been involved in unacceptable practices, it may sanction the provider in several different ways. The provider will typically receive a letter (Notice of Proposed Action) from the Department of Health informing the provider that the they are about to sanctioned for the particular conduct and that the agency proposed an administrative action. The possible sanctions include exclusion or censure. The provider has 30 days from the date of the Notice to submit any documentation or written arguments against the proposed agency action.

Who Can be Sanctioned

A common misconception is that only healthcare providers directly involved with the case can be sanctioned. That is not true. Any affiliate of the provider may be subject to Medicaid exclusion by affiliation of the government believes that the facts and circumstances of the case support this. Here are some common examples of affiliated persons that can be sanctioned:

  • Business partners or those with an ownership or controlling interest in a provider;
  • Employees and managers of the provider;
  • Provider’s subcontractors who earned more than $25,000 a year from dealing with the provider.

What happens once the provider is suspended

If a person is notified that he has engaged in unacceptable practices, Medicaid will withhold all payments to that person both for the present claims and the claims, which have been subsequently received. All payments will usually be suspended pending a resolution of the charges.

You have the right to an administrative hearing to determine if you engaged in the unacceptable practice and you must request the hearing within 60 days of the date of the notice.

If it is determined that you have been engaged in unacceptable practices, the Department of Health may do one of the following:

  • Exclude you from being a Medicaid provider
  • Freeze and withhold all payments
  • Censure you
  • Demand restitution payments for the funds it believes you were not entitled to receive.

Notice of Immediate Sanction

Although in most cases the provider is given time to address the notice of proposed action as explained above, in some cases the DOH can issue a notice of immediate sanction on 5 days notice. This can happen in the following cases:

  • The provider has been suspended from Medicare
  • The provider has been convicted of any Medicaid or Medicare fraud crime
  • The provider has been charged with a healthcare felony crime;
  • The provider has been found guilty of professional misconduct by a licensing agency and the misconduct is something that would constitute an unacceptable practice under the Medicaid regulations.
  • The DOH believes that the person’s further participation in the Medicaid Program will endanger the public.

In the provider has been sanctioned in this manner, there is no right to an administrative hearing but he would have to respond within 30 days of the date of the notice of immediate sanction with any materials and arguments challenging the action. The appropriate grounds for such an argument would be that the action is based on mistake of fact or is otherwise inappropriate.

Any provider convicted of a felony offense that occurred after January 1, 1997, related to health care fraud is subject to automatic exclusion from Medicare or Medicaid for at least five years. The law provides for a minimum of three-years’ exclusion in cases that involve convictions of Medicare or Medicaid fraud.

Certain government agencies on state and federal level have essentially discretionary powers to exclude any provider whose participation in the government-funded program would in their opinion endanger the program.

Reinstatement to the Medicaid program

A provider who has been sanctioned may request reinstatement to the Medicaid program or removal of any condition or limitation on participation in Medicaid. When you can make this reinstatement application depends on several factors. Essentially, the reinstatement process is similar to the original enrolment application process but the sanctioned provider has a duty to demonstrate that the violations that led to sanction will not be repeated.

How to find best attorneys for NY OMIG and Medicaid Exclusion cases

A criminal conviction or a disciplinary action may adversely affect a physicians panel membership or hospital privileges. Entities such as insurance companies, hospitals, and HMOs have implemented procedures to determine their member’s fitness and have their own standards for accepting and dismissing physicians.

Different situations require various approaches. In cases involving audits experienced OMIG attorneys can prevent agency actions by timely designing OMIG compliance programs or working out settlement deals that do not involve extreme actions. In cases involving professional discipline in which providers are excluded from the program, an appeal could be taken to reverse the decision.

Charle Butler
Charle Butler
I was hesitant to hire the Spodek Law Group. I read reviews and knew they have a great reputation. However, I thought I would spend money and not see or speak to my attorney. From the beginning to end of my case Todd and the entire staff were available and willing to help. We worked towards and end result that was way above my expectation and Todd delivered. I am forever grateful for patience and long days and night spent working on my case. Thanks Todd and the entire team!
Mesonista parsons
Mesonista parsons
My attorney at Spodek was Abigail. She was very knowledgeable and helpful with all my questions and concerns, as well as responsive. Her fees are affordable and Abigail took the time to make sure I understood everything relating to my case. I highly recommend Abigail and will request her services in the future.
debabrata chakraborty
debabrata chakraborty
Todd A Spodek is the experienced and best criminal lawyer at USA. He is very professional and always respond on time. Alex also very cooperative and always help me. They took care me and my problem like family member. I am 100% satisfied for their professional service. My result was unexpected and amazing. They dismissed my case. I am really grateful to them. I will recommend you to go there if you want to solve your problem. I wish all the best for them.
Asata Hendricks
Asata Hendricks
Truly appreciate the work the guys did!. Exceptional team & I know they care about each and everyone of their clients. I am super thankful to be referred to Spodek Law Group and I am grateful Todd & Alex were able to work diligently to achieve an outcome I am pleased with. Despite COVID they stayed on top of things and kept me informed every step of the way. Very thankful.
Mike Moroff
Mike Moroff
I'm very satisfied with the services rendered by Todd, Alex and Mary Lou. I whole heartedly recommend Spodek Law Group . I've worked with and have retained other attorneys in the past with Todd's firm being the cream of the crop for many reasons. A very serious legal matter was resolved after a year's hard work and effort. Todd expertly guided me through the process and was able to navigate and make the good journey bearable as well as successful. Mary Lou initially provided excellent assistance before referring my case to Todd. Alex's support was effective and timely. The customer portal (MyCase) is an invaluable communication tool that also kept track of my case. Various aspects of my case were explained and there were several options provided but I made the final decision of how the case would be handled. The legal fee was reasonable considering the effort and amount of work plus it was a flat fee regardless of the length of time required to conclude my case. Todd made himself available to me and we had many scheduled meetings to go over the progress and to discuss the next steps. I felt more confident after many discussions with him. You will not go wrong choosing Spodek Law Group for legal matters.
Josh Katz
Josh Katz
Being that it was the first time that I was in need of an attorney, I was afraid and hesitant and knew I needed the absolute best. It is beyond understood why Spodek Law Group has a reputation of being the top, if not the best law firm in New York. Alex and Abigail were there every step of the way even at the most unconvenient hours. I could not have asked for more. They are extremely good at what they do and they delivered much much more than just winning my case. A big thank you to Alex and Abigail for all the guidance and counseling and their upmost loyal support that extended far more than just legally. If you need the absolute best than don't hesitate to hire Spodek Law Firm.
I cannot tell you how thankful I am to Todd and Alex for their hard work and dedication to my case. I had never been in any trouble before but I had an unfortunate event occur and in the midst of COVID-19 at that therefore I knew I needed a team that was dedicated to my success. Today- my case has been finalized and I’m walking away with no record and can continue life as a mother and a Grad student worry free. I cannot express enough gratitude for their assistance.
AnnMarie Soliman
AnnMarie Soliman
I received a summons and called Spodek law group for a free consultation. Alex took my call and was very quick and responsive. He was available anytime through multiple platforms and very reassuring when needed. They are extremely organized and thorough. They got my case dismissed! I’m very grateful. Thank you Alex and Todd!



Spodek Law Group have offered me excellent support and advice thru a very difficult time. I feel I've dealt with someone who truly cares and wants the best outcome for you and yours. I'm extremely grateful for all the help Spodek Law Group has offered me. I can't recommend them enough.

~ David Bruce

Spodek Law Group was incredibly professional and has given me the best advice I could wish for. They had been helpful and empathetic to my stressful situation. Would highly recommend Spodek Law Group to anyone I meet.

~ Rowlin Garcia

Best service I ever had. Todd is absolutely class personified. You are in the safest hands with spodek. They have their clients interest in mind.

~ Francis Anim

Spodek Law Group

White Glove Service

We provide superior service, excellent results, at a level superior to other criminal defense law firms. Regardless of where your case is, nationwide, we can help you.

Hear From Our Clients

"Spodek Law Group have offered me excellent support and advice thru a very difficult time. I feel I've dealt with someone who truly cares and wants the best outcome for you and yours. I'm extremely grateful for all the help Spodek Law Group has offered me. I can't recommend them..."

David Bruce

"Spodek Law Group was incredibly professional and has given me the best advice I could wish for. They had been helpful and empathetic to my stressful situation. Would highly recommend Spodek Law Group to anyone I meet."

Rowlin Garcia

"Best service I ever had. Todd is absolutely class personified. You are in the safest hands with spodek. They have their clients interest in mind."

Francis Anim
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