Criminal prosecution of cases involving medicaid fraud are on the rise in New York State, and it is the job of the New York State Office of the Medicaid Inspector General (OMIG) to investigate and prosecute individuals, entities and/or health care providers who intentionally commit medicaid fraud http://www.ny.gov/agencies/office-medicaid-inspector-general.
The Medicaid program is run by State and Federal governments, as such if you are accused of medicaid fraud you may be subject to prosecution under State and Federal law. Here, we will examine the charge of medicaid fraud, who can be charged, penalties, defenses, and other legal aspects involving medicaid fraud to determine if you need an experienced medicaid fraud criminal lawyer to protect your rights.
Pursuant Title 18 U.S. Code §1347 a charge of medicaid fraud involves the intentional misrepresentation of facts in order to receive an unauthorized or ineligible benefit http://www.law.cornell.edu/uscode/text/18/1347. New York State also has penal laws that classify medicaid fraud anywhere from a class A misdemeanor, to fraud in the first degree, which is a class B felony and carries more significant penalties.
What to do if you have been charged with medicaid fraud?
Allegations of medicaid fraud should be taken very serious. The first thing you should do is examine whether or not there is any merit to the allegations, or if it is simply the result of harmless error, or inadvertence. Second, determine if the allegations are still at the investigative level or if formal charges have been filed. If formal charges have been filed you should speak with an attorney as soon as possible.
Who commits medicaid fraud?
Medicaid can be committed by any person or entity that intentionally provides medicaid with false or inaccurate information or documentation to receive a benefit for which they would not otherwise be entitled to. However, the medicaid fraud is commonly committed by patients, doctors or medical providers, and/or insurers.
There are numerous ways a patient may be committing medicaid fraud including, but not limited to 1). Submitting a claim for services or treatment they did not receive. 2). Providing false or inaccurate information on the application for benefits; or 3). Using another persons medicaid coverage for unauthorized treatment or services.
Medical Provider Fraud
There are also numerous ways a doctor or medical care provider can take advantage of, and defraud the medicaid program. Three commons frauds are: 1). Billing medicaid for services or treatment not rendered. 2). Accepting or receiving bribes or payoffs for patient refers ; and 3). Ordering unnecessary tests and/or scheduling excessive non-essential visits and treatments.
Insurers are also not immune to the potentiality of committing medicaid fraud. In fact, common frauds committed by insurers consist of the following: 1). Denying a valid claim submitted by a patient or healthcare provider. 2). Accepting a claim that they know is unacceptable or in violation of benefit policies and procedures; and 3). Falsifying information to a participant in order to sell a particular plan, product or service.
The severity of the penalties you face with a charge of medicaid fraud depends greatly on the individual facts of your case. However, this charge can be prosecuted under State and Federal, which range from a Class A misdemeanor, to a Class B felony. Needless to say, the penalties can also range from fines and formal probation, restitution or incarceration.
Not every charge of medicaid fraud ends in a conviction. In fact, an experienced medicaid fraud criminal lawyer can immediately begin formulating your defense or presentation of mitigating circumstances that help exonerate or reduce the fallout of these allegations. In any event, you should be with a lawyer as early in the case as possible. In many cases a skilled attorney can contact the right people in charge of the prosecution, in order to subvert any further unnecessary investigation into the matter by asserting a strong and compelling defense.
Other Legal Ramifications
In addition to the legal charges and penalties associated with medicaid fraud, you may also be subjected to other legal ramifications as well. For example, a doctor who has been convicted of medicaid fraud can lose his or her license to practice medicine, or can have other professional licenses revoked or suspended. Likewise, patients who have been found guilty of medicaid fraud may be ineligible to receive such benefits in the future, despite need or eligibility. Insurers who commit medicaid fraud can lose their professional license and be permanently barred from ever participating in the medicaid program.
Allegations and/or charges of medicaid fraud are very serious. If you have been accused of medicaid fraud it is imperative that you speak with an experienced criminal defense attorney right away.
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