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The Spodek Law Group understands how delicate high-profile cases can be, and has a strong track record of getting positive outcomes. Our lawyers service a clientele that is nationwide. With offices in both LA and NYC, and cases all across the country - Spodek Law Group is a top tier law firm.

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Why Clients Choose Spodek Law Group

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New York Medicaid Fraud Legal Guide

By Spodek Law Group | August 2, 2015
(Last Updated On: July 26, 2023)

Last Updated on: 26th July 2023, 10:54 pm

What are the types of Medicaid Fraud in New York

There are two categories of people who are investigated and prosecuted for fraud: benefits recipients and providers.
If you’re a Medicaid Recipient, you may be guilty of Fraud for the following:
• Providing false information on the Medicaid application (lying or concealing information about income, assets, etc.)
• Altering or forging prescriptions
• Re-selling medicine and products obtained through the program
• Receiving services for which you are not eligible by means of intentional misrepresentation
• Allowing another person to use your medicaid card to obtain services
• Receiving and using several Medicaid Cards.
If you’re caught doing any of the above, you will very likely need the services of a NY medicaid fraud lawyer.
If you’re are a Provider in NY, you could be investigated for Provider Fraud if you:
• Billing Medicaid for services that have never been provided
• Filing claims for fake services and medical conditions
• Filing claims for fake and staged car accidents
• Coverage claims for non-existent illnesses
• Filing claims for medical care coverage for staged, fraudulent auto accident injuries
• Illegal fee sharing
• Billing for services provided by unlicensed personnel in NY in violation of Medicaid rules.
As with Medicaid recipients, if you’re caught doing any of the above, you will likely need the services of a NY Medicaid fraud attorney.

What To Do If You’re Investigated For Medicaid or Family Health Plus Fraud

In many cases, clients first learn that they are the target of a Fraud investigation in NY when they receive a letter from the Human Resources Administration. Medicaid eligibility rules are clear and strict. You are not eligible to receive Medicaid or Family Health Plus unless you live in the state. You also are ineligible if your income is too high, depending on your family size. Finally, between 2006 and 2010, you would be ineligible for Medicaid if your family assets exceeded $20,000, which includes any real property other than the primary residence.
The Bureau of Fraud Investigations in NYC and the Division of Claims and Collections, both located at 250 Church Street and 151 West Broadway in Manhattan , as well as other agencies, routinely investigate matters related to fraudulent receipt of Medicaid benefits. Lately, there has been a substantial increase of criminal prosecutions for fraud of individuals who received health benefits illegally.
If you receive a letter from an investigative agency asking you to come to their office for an “interview” and to bring along certain documentation, you should seek legal advice from a NY Medicaid Fraud Lawyer immediately before discussing anything with the investigators.
If you go to the interview without a lawyer and voluntarily submit requested documentation you may be implicating yourself and confessing to having committed a crime (specifically fraud) and in the event your case is referred to the local District Attorney’s Office for criminal prosecution or to the Legal Department for civil litigation, any information your provide will be used against you.
If the HRA decides to press charges, the case will be referred to the District Attorney’s Office and the recipient will be indicted for several felony charges including grand larceny, Fraud, and other charges. Many clients found out that they had been targeted only upon receiving a call from the DAs Detective Squad instructing them to surrender to the DAs Office and face the charges.
Our NY Medicaid Fraud lawyers have helped countless individuals investigated for Fraud within the city. In many cases, our lawyers have been successful in preventing the HRA from filing criminal charges! If you or someone you know in NY is contacted by investigators in regards to fraud, do not be part of the statistics. Speak to a NY Medicaid Fraud Lawyer today for a confidential consultation.

What if you’re a service provider

If you are a provider of Medicaid-sponsored services, you may also receive a letter or a call from an investigating agency in NY requesting an interview or asking you to submit your files to them for examination. If this happens, call an experienced New York Medicaid fraud attorney right away.
If you are a provider investigated for fraudulent Medicaid related activities, you may receive written communication from a variety of governmental agencies – from the Office of the Attorney General to the Office of Inspector General to the U.S. Government Accountability Office. On some occasions, NY agents may simply raid your office and seize your files and computers. When you realize that you are subject to a governmental investigation, talk to one of our attorneys before talking to the investigators!
If you are under investigation, the “do-it-yourself” approach is wrong. How the case in handled in the investigative stage often determines the outcome, including the likelihood of whether criminal charges are filed against you within the NY metro area. These charges are not “minor” – we urge you to get a lawyer.
A consultation with an attorney is absolutely critical before you discuss anything with the investigators setting up a prosecution for fraud.
Your chances of a favorable outcome increase dramatically if an attorneys begins your defense in a Medicaid or health care fraud case early, hopefully before indictment. The government has already invested considerable time and resources in gathering evidence and building its fraud case against you. They are ahead of the game and the sooner your lawyer gets involved the better your chances. You need an experienced and dedicated legal team of lawyers to beat the fraud investigators at their own game.

What To Expect If Criminal Charges Are Filed Against You

These types of fraud crimes are actively investigated and prosecuted. If your case is not properly handled by an attorney – administratively at the early investigative stage – criminal charges are likely to be brought. You may be accused of several felonies including grand larceny, false filing, fraud, etc. You will pay restitution and fines, be banned from receiving or participating in Medicaid, have a criminal record, and may even go to prison or face deportation. A NY Medicaid fraud attorney might be the only way out.

Can I Be Deported For Medicaid Fraud?

As someone who is concerned about your own health or the health of your children or other family members, you might have done what you could to get Medicaid for you and your loved ones. It can sometimes be difficult to qualify for Medicaid, and it can be impossible if you are an illegal immigrant. However, it is understandable that you might want to do what you can to ensure that you and your family members have coverage.
If you have been approached by a Medicaid fraud inspector, however, you might be concerned about two things: getting in trouble for Medicaid fraud, and possibly being deported. Since these are two things that you probably want to avoid at all costs, it’s a good idea to learn as much as you can about Medicaid fraud and its potential effects on you and your family. Luckily, doing your research and hiring a good attorney can help you through this troubling and stressful situation.
What You Can Do to Prevent Deportation For Medicaid Fraud
If you are afraid that you might be at risk of being deported due to Medicaid fraud or an accusation of fraud, then you could be wondering what you can do. Luckily, there are things that you can do to help keep yourself safe from these consequences. These are a few things that you should start focusing on now:

  • Gathering Helpful Documentation – If you have any documentation that shows that you did not commit Medicaid fraud, or if you have documentation that some of the above-mentioned mitigating factors might apply to you, then you should gather up all of this evidence.
  • Hire an Attorney – You should never try to deal with something like this on your own. To help protect yourself from too much legal trouble and from deportation, it is best to hire a trustworthy lawyer who has experience in these matters. Then, you will have someone who can help you file the appropriate paperwork and who can defend you in court. This can help you ensure that you can stay in the country without any major legal repercussions.
  • Stay Out of Trouble – Getting in legal trouble can put you at a much greater risk of deportation. Therefore, it is important to stay out of trouble. It’s best to avoid getting even a minor traffic ticket or other simple citation until the situation has been handled.
  • Save Up Some Money – You will need money to hire a lawyer and handle any legal fees. Therefore, it’s best to start saving now so that you will have this money when you need it.

Mitigating Factors to Help Prevent Your Deportation
Luckily, there are some mitigating factors that can help you prevent deportation, even if you are guilty of Medicaid fraud. These are a few mitigating factors that you can fight for to help stay in the country:

  • You have lived in the United States of America for more than five years and have never been in trouble with the law.
  • You plead guilty in exchange for a lesser charge that is not a felony or aggravated crime, such as if a lawyer helps you get a plea deal.
  • You plead guilty to committing fraud for less than a certain amount.
  • You do not have to serve any jail time due to your guilty plea or your conviction, or you serve a short sentence, such as one that lasts for one year or less.

Dealing with an accusation of Medicaid fraud can be terrifying, especially if you are worried that there is a chance that you could be deported because of it. You shouldn’t panic, however; instead, you should focus on getting the help that you need to hopefully stay in the country.

New York Medicaid Fraud Lawyer

If you have been accused, you need the expertise and dedication of a New York Medicaid fraud lawyer. As soon as you discover that you are under investigation for Medicaid or health care fraud, call our criminal defense attorneys immediately. If you are a health care provider, you have too much to lose if you are convicted, and that includes your professional license.

In New York, there are two categories of people who are investigated and prosecuted for Medicaid fraud: benefits recipients and providers. Some possible reasons for fraud investigation include providing false information on the Medicaid application, altering or forging prescriptions, reselling medicines, receiving services by means of intentional misrepresentation, and billing Medicaid for services that have never been provided.

Depending on the circumstances of the case, individuals accused of Medicaid fraud may face criminal charges, including grand larceny and Fraud, which could lead to restitution, fines, and potential deportation for undocumented immigrants. To address these cases, it is crucial to consult with an experienced New York Medicaid fraud attorney to help navigate the situation and minimize potential consequences.

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