Medicaid fraud is a serious crime in the United States. Each year, Medicaid fraud costs the country an estimated $140 billion, an amount that is equivalent to more than 3 percent of the nation’s total tax revenues.
Because Medicaid fraud is such a widespread and serious problem, state and federal agencies have been given a broad mandate to combat it. Increasingly, state and federal agencies are deploying state-of-the-art means to fight against those who would take advantage of the U.S. healthcare system to unfairly enrich themselves at the expense of their fellow citizens’ health. But this increase in enforcement efforts has also led to a wide net that often captures those who may not deserve the harsh penalties and life altering criminal convictions that they are facing.
If you find yourself under investigation or formally charged with Medicaid fraud, the most important thing to remember is that you should always get the help of a competent attorney on your side. Hiring the right attorney, with the knowledge, skills and experience to successfully bring your case to a satisfactory resolution, can make the difference between paying a small fine and some restitution versus being sent to state prison.
With toughened enforcement measures, even small mistakes can get you in hot water
The increased prevalence of Medicaid fraud has caused a backlash by law enforcement across the country. Unfortunately, many people who don’t really have any intention of committing fraud are often swept up in these efforts. The truth is that even minor oversights, such as not reporting income from a side job, can very quickly land you hot water with the Human Resource Administration, the state body responsible for investigating cases of welfare fraud in New York State.
Regardless of whether or not you have any idea why you have come under HRA scrutiny, always remember that the first thing you should do is contact an experienced attorney.
An HRA letter means you are under investigation
Medicaid fraud cases often unfold very differently than other cases. For starters, almost all Medicaid fraud cases in the state of New York are handled by an agency called the Human Resources Administration. On top of this vanilla-sounding, bureaucratic name, the HRA begins almost all investigations by sending a banal-sounding letter. These letters may look little different from any other government correspondence and usually request that the recipient come in for an interview.
Don’t do it.
Once you receive an HRA letter, you should assume that you are under investigation for serious fraud. The agents handling your case will not let you know what evidence they have on you. But in our experience, once the letter is sent, agents from the HRA have likely already spent dozens of hours investigating your case. At this point, they have evidence against you and suspect that you committed serious fraud. The agents are not looking to casually chat with you. They will be using every trick in the book to get you to make an incriminating statement and impeach yourself.
This is why it is crucial to contact an experienced attorney the moment you receive an HRA letter. An experienced Medicaid fraud attorney knows the process inside and out. They know what information they will have to provide, which requests they must comply with, when to fight head on and when to wait for a better moment. In general, you are not compelled to cooperate with HRA investigators, as they are not fully sworn law enforcement officers. However, at some point, your lawyer may determine that it is advantageous to open negotiations with the HRA.
A good lawyer can minimize your penalty
The good news is that, once you have hired a competent attorney, there are many different mitigating factors and other means by which your lawyer can negotiate the best possible settlement. In our experience, the vast majority of Medicaid fraud cases do not end in any prison time for the client. This is especially true where the client is a mere recipient and is not involved in the provision of medical services.
However, jail time is not the only thing to worry about. Without following the advice of a competent Medicaid fraud lawyer, you may quickly find yourself facing a crushing choice – either go to jail for months or pay tens of thousands of dollars in restitution. Most people will choose the latter. But the prosecutor and judge will be looking to get as much of the perceived loss back as they can.
But with the help of a good lawyer, it is possible to dramatically reduce the fines and restitution that you may be forced to pay. The mere threat of a good lawyer taking a case to trial, tying up limited and expensive court resources for hundreds of hours, often provides enough bargaining power to reduce fines and restitution costs by 50 percent or more.