Health costs have been soaring in the United States since the early 1970s. One source of the uncontrolled increases in medical costs for U.S. citizens has been the steadily increased incidence of fraud that has taken place over the last 30 years. In particular, Medicaid fraud is a tremendous problem that has strained the healthcare system, directly contributing to higher costs for all patients and worse outcomes as a result of unnecessary treatments and ineligible parties being treated, tying up valuable and limited medical resources.
In fact, it has been estimated that Medicaid fraud alone costs more than $140 billion each year. This staggering sum represents over 3 percent of the total revenue that the federal government takes in. At the end of the day, such astonishing levels of fraud make it more expensive for everyone to receive the healthcare they need.
As a result of all of the fraud taking place throughout the Medicaid system, state and federal governments have begun cracking down on cases of fraud. The number of investigations in states like New York has exploded over the last decade, yielding much higher rates of conviction for Medicaid fraud but also catching many small fish in its wide net.
Even though you may not think you have done anything wrong, simple oversights, such as not fully declaring income or assets, can put you in the sights of over zealous enforcement agencies. In New York State, the agency that investigates cases of Medicaid fraud is the Human Resources Administration. Even if you believe that you have done nothing wrong, if you are contacted by the Human Resources Administration, you should immediately contact an experienced, qualified lawyer to help you navigate the investigation process. Medicaid fraud is a serious crime with serious penalties. You need to have an expert by your side to help you through the difficult process of clearing your name.
If you receive an HRA letter, you are a target of an ongoing investigation
The Human Resources Administration may sound like a boring bureaucracy. They will also send benign-sounding, boilerplate letters to residents, disarming any sense in the recipient that something is wrong. But make no mistake, if you receive a letter from the HRA, no matter how banal it sounds, it means that investigators have already built a strong case against you and believe that you have committed a serious crime.
Unlike most other crimes, Medicaid fraud cases are not handled by the police. However, this should not trick you into complacency. If you receive a letter asking you to come in for an interview, you should realize that it is a legal proceeding that will likely result in you making incriminating statements that will later be used against you. It is absolutely imperative to understand that if you are summoned to an interview with the HRA, you must immediately contact a lawyer.
You are not always required to attend meetings with HRA agents. And a lawyer’s presence can mean the difference between a slam-dunk case, resulting in serious prison time, and having the case completely dismissed.
For the same reason that you should never talk to police without a lawyer present, you should not talk to investigators from the HRA. Going in for an interview with investigators carries great risk but virtually no reward. They employ expert investigators with years of experience in eliciting incriminating statements and confessions. You should not play their games if you don’t have to.
Medicaid fraud cases often have lots of mitigating factors and choke points
Even if you have done something that you know you shouldn’t have, the chances are that any Medicaid fraud case that can be built against you will give you opportunities to dramatically reduce the penalty. One way this can be accomplished is through mitigating factors.
In the case of Medicaid fraud, simple oversights like incorrectly reporting income usually do not rise to the level of criminal intent. Regardless of the circumstances that led to these mistakes, the prosecution may often find it difficult or impossible to prove that there was actually intent to defraud. This can drastically reduce the potential penalties involved. In particular, it can take the possibility of prison time off the table.
Additionally, Medicaid fraud cases are brought to trial at far higher rates than other criminal proceedings. All prosecutors understand that, due to the collateral consequences involved in convictions, such as medical personnel having licenses revoked, many defendants will fight their cases to the bitter end, duking it out in court rather than accepting a career-ending plea bargain.
This means that prosecutors are often especially willing to make generous plea deals in Medicaid fraud cases. Because they are afraid of tying up valuable criminal justice resources for hundreds of hours to prove a $5,000 Medicaid fraud case, they will often make generous plea deals. In most cases, serving no jail time will be on the table.