Here’s an article by Alex Z, a member of the Spodek Law Group, a team of Long Island Divorce lawyers. Every year, New York State sees billions of dollars in losses due to Medicaid fraud. This represents a huge problem for the taxpayers of New York state and the United States as a whole. It has been estimated that over $140 billion is lost, nationally, each year to Medicaid fraud. This has made the problem a top enforcement priority, with the number of cases brought to court over the last decades expanding dramatically.
But with increased enforcement efforts come more people getting caught up in the wide net of the Medicaid fraud investigatory apparatus and the court system. If you have become the target of an investigation concerning Medicaid fraud, the first thing that you need to do is to contact a qualified and experienced attorney. The sooner in the process you contact a lawyer, the more likely it will be that your case will have a favorable resolution and that you will not be subject to jail or prison time.
Unlike most other crimes, in the state of New York, Medicaid fraud is investigated by a civilian agency, the Human Resources Administration. Although this bureaucracy may send you letters that look similar to any you may receive concerning other government business, if you have been asked to come in for an interview, you should immediately contact a lawyer.
The HRA interview process is nearly unique in the criminal justice system of New York State because these interviews are little different from being interrogated by a detective. Because you are not under arrest, everything you say and do can and will be used against you, but the investigators are under no obligation to inform you of this fact.
Despite the friendly looking, boilerplate letter format and the banal language that these requests entail, if you have received an HRA request for an interview, you are already the target of a serious investigation. This means that investigators have already likely spend dozens or even hundreds of hours amassing information on your case. The sole purpose of conducting these interviews is to get the person being investigated to make self-incriminating or impeaching statements. You have absolutely nothing positive to gain by attending one of these interviews, and you should never interact with HRA investigators without a competent lawyer present.
For the same reason that a good lawyer will always tell you that you should essentially never talk to the police, a good Medicaid fraud lawyer will give you the same advice regarding HRA investigators.
If you follow that advice and the prosecutor decides to eventually charge you anyway, Medicaid fraud is actually one of the best crimes you can be charged with. This is because there are a large number of potential mitigating factors, the charges are often hard to prove and Medicaid fraud cases impose a unique strain on the court system. These three factors can provide you and your lawyer with enough leverage to significantly reduce penalties, fines and restitution amounts.
Many of the reasons that people first come under the scrutiny of the the Human Resources Administration have innocent explanations. For example, it is both common and easy to forget to report that you made a certain amount of money from a side job. Likewise, many people legitimately forget to declare that their new employer gives them certain health insurance benefits. Because mistakes in reporting these factors are often innocent in nature, they can provide powerful mitigating circumstances in negotiating plea deals or at sentencing in a trial.
However, many of these same factors are even more powerful when seen as a deterrent to the prosecutor choosing to take the case to trial in the first place. The truth is that Medicaid fraud cases, especially those involving mere recipients, make it notoriously difficult for the prosecutor to prove that there was criminal intent to defraud beyond a reasonable doubt.
Just one example of this would involve someone who claims that they didn’t declare a certain amount of side income because they didn’t understand the dizzyingly complex laws surrounding benefits eligibility. Most jurors find these sorts of defenses completely convincing, as most normal people have a difficult time comprehending even the basics of healthcare laws.
This leads to what is, perhaps, the most powerful reason to hire an experienced attorney. A good lawyer can quickly make a prosecutor think twice before risking hundreds of man-hours and tens of thousands of dollars prosecuting a case that they will likely lose. This is one reason that Medicaid fraud cases are among the most easily negotiated and least likely to produce jail time.
With the right lawyer, your case will almost certainly have a good outcome.
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