What Is Medicaid Fraud?
A simple definition of Medicaid fraud is that it’s any use of false information to receive Medicaid benefits. The most obvious examples of this would be providing false information when applying for Medicaid in order to qualify for benefits.
For example, if you have multiple sources of income but you only list one on your Medicaid application, that would be Medicaid fraud, because you’re providing a lower income to meet the low-income threshold. Another common example of Medicaid fraud is failing to disclose certain assets, such as real estate, on the application.
Even if you provide accurate information on the Medicaid application, you could still commit Medicaid fraud if your situation changes and you don’t update your information with Medicaid. When you apply, you must agree that you’ll notify Medicaid of these changes. Potential changes Medicaid must know about includes a change in income or with your living situation. It’s easy to forget to do this, but it’s your responsibility when you’re receiving Medicaid benefits.
Possible Penalties for Medicaid Fraud
As mentioned, Medicaid fraud is a type of welfare fraud. There are multiple degrees of welfare fraud. Here is each offense and its class:
• Welfare fraud in the fifth degree is a class A misdemeanor
• Welfare fraud in the fourth degree is a class E felony
• Welfare fraud in the third degree is a class D felony
• Welfare fraud in the second degree is a class C felony
• Welfare fraud in the first degree is a class B felony
The degree of the fraud will depend on how much you fraudulently obtained in terms of benefits. Welfare fraud in the fifth degree applies if you fraudulently obtained Medicaid benefits for up to $1,000, whereas welfare fraud in the first degree would require that you fraudulently obtained Medicaid benefits for over $1 million.
Penalties obviously become more severe as the offense class increases. Any of the five degrees of welfare fraud can include jailtime and fines, and you could be barred from receiving any Medicaid benefits in the future. Jailtime is rare with cases of Medicaid fraud, especially when you have a skilled New York Medicaid fraud criminal lawyer to prepare your defense and possibly negotiate a plea deal for a lower class of fraud.
Potential Legal Mitigating Factors
Just because you’re being accused of Medicaid fraud doesn’t necessarily mean the fraud investigation unit has an airtight case against you. Medicaid fraud investigation often starts with a tip, as whistleblowers can receive financial compensation for tipping off investigators. This desire for a reward can lead to tips implicating people who actually haven’t committed any sort of fraud.
The best defense to allegations of Medicaid fraud is having proof that all the information provided on your application was and remains accurate. If there are any inaccuracies, proving that this wasn’t intentional could make all the difference. It’s only fraud if you intentionally used false information to obtain benefits. An honest mistake wouldn’t qualify, although you would need to be able to prove this.
Defending Yourself Against Charges of Medicaid Fraud
The most common way for a Medicaid fraud case to begin is with a letter from New York’s Fraud Investigation office. This letter will request that you come to an office to talk to investigators about the charges, and it may also request that you bring certain documents with you.
Your best bet is to contact a New York Medicaid fraud criminal lawyer as soon as you receive this letter. The fraud investigators are hoping that you come to the meeting alone, provide all the documents they wanted and answer all their questions. This is ideal for them, but not for your defense, because they will hold all the cards.
When you consult with a lawyer, your lawyer can go over the evidence against you and advise you on what to do going forward. They can go to the meeting with you, let you know what documents to bring, and tell you what questions you should and shouldn’t answer.
Depending on the circumstances of your case, your lawyer may feel that there’s insufficient evidence against you or that the fraud investigators could have a valid case. In the latter scenario, your lawyer can attempt to negotiate a favorable agreement for you. It may be possible for you to simply pay a settlement amount as restitution and close the matter without admitting any guilt.