One of the biggest concerns in healthcare today, Medicaid fraud is a growing problem in many states. According to the Government Accountability Office, in 2015 alone improper payments for services not covered by Medicaid or for services that were billed but never rendered totaled more than $29 billion. Because of this, funds that could otherwise be used for legitimate services are instead wasted on these fraudulent claims, which results in increased costs for many services. More information about this can be found at www.ncsl.org/research/health/medicaid-fraud-and-abuse.aspx. If you find yourself being charged with Medicaid fraud, it’s a serious matter that could lead to significant financial penalties as well as jail time.
Defining Medicaid Fraud
The basic definition of Medicaid fraud is knowingly using false information to apply for and receive Medicaid benefits. Because eligibility for this program revolves around a person’s level of income, this is usually the area that is most often misrepresented. However, failing to disclose assets such as real estate is also considered fraud, as is failing to notify your Medicaid office of any changes to your financial or living situation. Even if you simply forget to make the notification, you can still be accused of fraud.
What are the Penalties?
Since Medicaid fraud falls under welfare fraud, there are varying types of offenses depending upon how much money was received. For lesser amounts that total no more than $1,000 dollars, it would be classified as a misdemeanor. However, anything above that amount becomes a felony, with the most serious being a first-degree felony, which is receiving fraudulent Medicaid benefits totaling more than $1 million. Needless to say, the higher the amount of fraudulent benefits you received, the more severe the penalties. In most cases you are fined and required to pay back any funds you obtained under false circumstances, but are rarely sentenced to prison for your offense. This is due to the large number of pending Medicaid fraud cases, which leads many prosecutors to be willing to negotiate a plea agreement with defendants, resulting in lesser penalties.
Are There Mitigating Factors?
When people hear of Medicaid fraud cases, most automatically assume the case is open and shut. However, that’s often not the case at all. In fact, there are numerous mitigating factors that usually come into play in these cases. When these emerge, a person who appeared guilty may all of a sudden be found innocent of all charges. This is due to being able to prove that the information provided on an application was complete and accurate, and is still accurate to the best of their knowledge. However, if there is information on the application that is inaccurate, that doesn’t necessarily point to fraud. Instead, being able to prove an honest mistake occurred will resolve the situation, although it’s vital you be able to prove this. And remember, these fraud investigations usually result from tips provided by a whistleblower, who will usually be compensated financially for the information. Therefore, it’s quite possible mistakes can occur, so be prepared for this possibility.
How Do I Defend Myself Against These Charges?
While these cases can be intimidating to those being accused of Medicaid fraud, it doesn’t have to be that way. While you may receive a letter from Medicaid fraud investigators requesting your presence in their office to discuss the case, there are certain steps you can take. For starters, gather all documents you have related to the matter, make copies of everything, and take them with you to the meeting. However, it’s crucial that you not go to that meeting alone. Instead, contact a knowledgeable and experienced criminal defense lawyer who specializes in Medicaid fraud. After doing so, discuss your case thoroughly and go over your options. In most situations, your lawyer will decide investigators lack the evidence needed for a conviction, or that they do have evidence which could result in a guilty verdict. In either case, have your lawyer attend the meeting with you. If they do, they may be able to negotiate an agreement in your favor, especially if the evidence seems to be against you.
Don’t Go It Alone
Regardless of the circumstances in these cases, don’t choose to go it alone. Investigators often count on this, hoping you will be too intimidated to think clearly. Instead, schedule a consultation with an attorney as soon as possible after receiving notification from investigators. According to the website Healthresearchfunding.org, more than 40 percent of Medicaid payments in New York are deemed “questionable,” making it more likely that investigators will take a closer look at your application. So rather than let yourself be caught off-guard by zealous investigators who may be determined to find fault no matter the circumstances, hire an experienced and knowledgeable Medicaid fraud criminal defense attorney to help you navigate this complex process.
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