Each year in the United States, more than $140 billion is lost to Medicaid fraud. This problem has only grown worse over the last few decades. As a result, state and federal agencies have grown more zealous than ever in their effort to stomp out cases of fraud wherever they are found.
This means that more cases than ever before are being prosecuted, and more people than ever before are being accused of Medicaid fraud, potentially facing life-altering criminal convictions, huge restitution and fine amount and even the prospect of spending years in prison. If you ever find yourself the object of a Medicaid fraud investigation, the most important move you can make is to quickly hire an experienced and knowledgeable attorney. While Medicaid fraud is a serious crime, it is often one of the most highly defensible types of cases that lawyers handle. Getting a competent lawyer on your side early in the fight can make the difference between prison time and a dismissal of your case.
In New York State, Medicaid fraud is investigated by the Human Resources Administration
Unlike many other forms of crime, Medicaid fraud, at least in New York State, is investigated by a civilian agency, the Human Resources Administration, not the police. However, this does not indicate that being targeted for investigation by this agency is not serious. On the contrary, many cases of Medicaid fraud result in the perpetrators being sentenced to prison and having to pay hefty fines and restitution.
If you receive a letter from the Human Resources Administration regarding your Medicaid eligibility, it is highly likely that you have become the target of an investigation. In our experience, if you have received a letter from the HRA requesting that you come in for an interview, it is nearly certain that you are under investigation for serious Medicaid fraud. This means that the investigators will likely already have compiled significant evidence against you. It is imperative that, if you receive a request for an interview, you should immediately contact a qualified and experienced lawyer to help guide you through the investigatory process. Failing to get a lawyer at this crucial stage will almost certainly result in far worse outcomes than would have otherwise been possible, had you quickly hired a lawyer in the first place.
With qualified counsel, you can often get a significantly reduced sentence
The above considerations should not get you down. Medicaid fraud is a crime that is uniquely prone to being negotiated down to lesser offenses and relatively lenient sentences. But it is crucial that you contact an experienced lawyer who knows how to maximize your chances of a favorable outcome.
In cases of Medicaid fraud, there are often many potential mitigating circumstances. Because Medicaid fraud is usually treated as a criminal matter, rather than a civilian one, the prosecution often has a high bar of proof that they need to meet at trial. Simple oversights, such as the misreporting of income or failure to notify of new employer benefits may have no element of criminal intent. Even in cases where there may have been an intent to defraud, the prosecutor will often have a very difficult time showing that to be the case.
Many actions that may lead to a Medicaid fraud investigation can be easily explained away as simple oversights or accidents. Yet, in other cases, it may be possible to defend against accusations of fraud by demonstrating that the defendant simply could not or did not understand the often highly complex rules, regulations and laws that dictate benefits eligibility. These are just a few of the mitigating factors that may make the difference between a long sentence and a case dismissal.
But only a competent lawyer will be able to give you the best possible defense by making use of all mitigating factors that may apply to your case.
Medicaid fraud cases are particularly hard on the court system
Medicaid fraud cases are also unique because they carry specific collateral consequences for those convicted. For example, someone who has been convicted of Medicaid fraud in one state, even if the case was a mere misdemeanor, may not be able to ever work in the healthcare field in most other states. This is a severely harsh punishment for what oftentimes ends up being little more than a thousand-dollar oversight.
Because of the severe penalties associated with pleading guilty to Medicaid fraud crimes, proportionally, far more defendants accused of Medicaid fraud will go to trial than for other crimes. This leads to a strain on the court system. As a result, Medicaid fraud is one of the crime categories that is most frequently pleaded down to a lesser offense. Because of the unwillingness of prosecutors to take these cases to trial, a good lawyer can very often arrange a favorable plea bargain.