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Queens Medicaid Fraud Lawyers

Understanding Medicaid Fraud

Medicaid fraud is when someone claims health care reimbursement from a Medicare program when they are not eligible. It is estimated that at least three percent of the Medicaid fund is fraudulently spent. The most common method of Medicaid fraud is failing to submit proper documents or submitting false ones. Some of the methods of document fraud include unreported assets, duplicate applications, unreported employment, or unreported income. Another form of fraud that is done by healthcare providers is phantom billing. The medical provider will bill for medical procedures and tests that were not needed or were not performed in this case. Patient billing is when the patient and the medical provider work together to defraud Medicaid. The patient will be asked to lie so that they can share the proceeds between them.

Penalties for Medicaid Fraud

Prison Time

Medicaid fraud is usually termed as a felony. This depends on the amount received and the context. The prison term could be increased if the accused has a prior criminal record. A felon loses the right to serve in a public office or to vote during elections. One could lose certain licenses including their visa. One can be deported if they are not US citizens and are found guilty of Medicaid fraud.


The fine that one will be ordered to pay is dependent on the violation and its severity. The fines range between five thousand and eleven thousand dollars per false claim if one violates the False Claims Act. This is a hefty fee. It is necessary because it discourages people from defrauding the government. Damages are also considered when the fine is being determined. It can be up to three times the amount that the government lost as a result of the false claims that were made in some cases. The Civil Monetary Payments Law caps the upper limit per violation to $50,000. There are assessments of up to three times the total amount that was claimed fraudulently for services and items.


One form of punishment is to reimburse the total amount of funds that one fraudulently received after a trial. The fines are usually set in place to help the government to recover the funds that they have lost. Restitution is applicable if the charges are not too serious and the amount is not that much.

George FernandezGeorge Fernandez
14:16 30 Apr 24
Excellent 10 out of 10, Helped resolve my case. Jeremy explained everything and made everything easy to understand.
21:33 24 Apr 24
If you are looking for a lawyer that listens, is aggressive where needed, and holds his word above all else, Todd is the best pick. I had hired multiple attorneys prior to hiring the Spodek Group for a white collar case. The first thing that stood out to me was the cost, as anyone going through the process and dealing with the system, money was tight at that time - especially after hiring and firing multiple lawyers. The cost was not as high as others which was definitely a plus. Todd's intake process was also unlike other attorneys. He took the time to actually listen. He cared. He was trying to put himself in my shoes while I was explaining the situation to him and he really took the time to understand the whole situation. Other lawyers will give you 15 mins and send you a retainer agreement. Not Todd, I think he spent almost two hours with me as I was explaining everything.Not only was he great during the onboarding process, he was supportive and very informative through the entire plea process and eventually sentencing. After hiring him, I asked if I should hire a prison consultant, he told me to save my money as he would do everything they would. He was right and held up to his word. Later on I would hear from others that went with the prison consultants that they were a waste of money - I am glad I listened to Todd!When it came time for sentencing, two days prior to sentencing, the prosecutor tried increasing my proposed prison time by almost double - apparently a normal move. Todd and his team worked with me non-stop through the weekend prior to sentencing to ensure that I was not given additional prison time. Again, he took the time to listen and came up with a strategy to explain the case with great detail.Unfortunately, I did plead guilty as that was my best option. Todd and his whole team wrote up nearly 300 pages of a summary of what happened and why I should not be given prison time. If I breakdown the amount I spent with Todd versus the amount of work that I saw being done, I am shocked I was not charged four times as much. The other benefit was, a lot of criminal defense lawyers were just a single attorney with a paralegal or two. Todd had a team of people that I dealt with (5-7 people that I interacted with), but he was ALWAYS accessible. It would never take him more than an hour to reply unless he was in court.I was sentenced to prison and I was emotionally distraught. Todd and his team did whatever they could even after sentencing to make sure I was alright. He personally stayed in touch with my family to ensure I was doing alright and offered support to them. Most lawyers would consider the job complete at sentencing, not Todd.After prison, Todd still spent time with me to make sure I was on the right track and avoiding any potential risks in the future. He has also been giving advice on how to navigate probation etc and has not been looking at the clock for billing.Although I wish I had never been arrested in the first place, I am glad I had Todd and his team in my corner. Without them I likely would have had to spend a lot more time in prison than I did.Thank you, Todd, and the entire Spodek Law team, for helping turn what was a nightmare into a manageable situation!
Yelva Saint-PreuxYelva Saint-Preux
19:26 19 Apr 24
I am immensely grateful to the entire team at Spodek Law Group for their unwavering dedication and exceptional expertise throughout my case. From our initial consultation to the final resolution, their professionalism and tireless advocacy made all the difference. Their strategic approach and attention to detail instilled confidence in me every step of the way.Thanks to their hard work and commitment, we achieved a truly favorable outcome that exceeded my expectations. Not only did they navigate the complexities of my case with precision, but they also provided invaluable support and guidance during what was undoubtedly a challenging time. I cannot recommend Spodek Law Group highly enough, especially attorneys Todd Spodek and Claire Banks; they are beacons of excellence in the legal profession.YSP.
Katherine SunKatherine Sun
18:08 18 Apr 24
my lawyer is Alex Zhik. Efficient, patient and professional
Nun yaNun ya
17:48 18 Apr 24
Todd, Ralph and Alex are amazing. Helped my husband get from a double digit number with multiple charges to a single digit, by the time I blink he will be out. They very professional and help with all your needs. They dealt with my anxiety and worry very well and they understand that your family member needs to get home as soon as possible.
Keisha ParrisKeisha Parris
20:45 15 Mar 24
Believe every single review here about Alex Z!! From our initial consultation, it was evident that Alex possessed a profound understanding of criminal law and a fierce dedication to his clients rights. Throughout the entirety of my case, Alex exhibited unparalleled professionalism and unwavering commitment. What sets Alex apart is not only his legal expertise but also his genuine compassion for his clients. He took the time to thoroughly explain my case, alleviating any concerns I had along the way. His exact words were “I’m not worried about it”. His unwavering support and guidance were invaluable throughout the entire process. I am immensely grateful for Alex's exceptional legal representation and wholeheartedly recommend his services to anyone in need of a skilled criminal defense attorney. Alex Z is not just a lawyer; he is a beacon of hope for those navigating the complexities of the legal system. If you find yourself in need of a dedicated and competent legal advocate, look no further than Alex Z.
Taïko BeautyTaïko Beauty
16:26 15 Mar 24
I don’t know where to start, I can write a novel about this firm, but one thing I will say is that having my best interest was their main priority since the beginning of my case which was back in Winter 2019. Miss Claire Banks, one of the best Attorneys in the firm represented me very well and was very professional, respectful, and truthful. Not once did she leave me in the dark, in fact she presented all options and routes that could possibly be considered for my case and she reinsured me that no matter what I decided to do, her and the team will have my back and that’s exactly what happened. Not only will I be liberated from this case, also, I will enjoy my freedom and continue to be a mother to my first born son and will have no restrictions with accomplishing my goals in life. Now that’s what I call victory!! I thank the Lord, My mother, Claire, and the Spodek team for standing by me and fighting with me. Words can’t describe how grateful I am to have the opportunity to work with this team. I’m very satisfied, very pleased with their performance, their hard work, and their diligence.Thank you team!
K MarK Mar
01:37 25 Jan 24
I recently had Spodek Law Group represent me for a legal matter in NYC and I am thoroughly impressed with their services.Alex Zhik secured the best possible outcome for my case.It was a seamless journey from the initial consultation to the resolution of my legal matter. From the moment I spoke to Todd about my case, his enthusiasm to help was evident, setting a positive tone for the entire experience. The efficiency and professionalism displayed by the team is commendable.A particularly noteworthy aspect of their service is their user-friendly portal to upload your documents/evidence. This not only simplified the process, but showcases their commitment to streamline the client experience.Lastly, in an industry where legal fees can often be a concern, I found their pricing to be very reasonable, making needing legal assistance feel accessible and stress-free.I am grateful for their support and wouldn't hesitate to turn to them again in the future.

Defense Strategies for Medicaid Fraud Charges


The type of defense strategy is dependent on whether it is a civil case or a criminal one. The government looks for a monetary reimbursement from the accused in a civil case. One faces a criminal indictment with the possibility of imprisonment if it is a criminal case.

False Accusations

One must detach themselves from the involved parties in this type of defense. This can be done by presenting paper records and pieces of correspondence from the two parties. One can be dragged into these types of cases if the accused wants to lighten the burden by showing that they had an accomplice. This argument can be made when one is accused of patient billing. One must show that they were not involved in any way and that everything was done without their knowledge. This is important because the burden is on the defendant to prove that they had no part to play in the fraudulent activities.

Coding and Billing Errors

Billing changes occur every time. One can show that they were not aware of the change. This can be proved easily if the amount in question is minimal. An attorney can help you in such a case if they have an understanding of coding policies. Fraud charges can arise because there is an error in one of the documents. It could involve unreported assets that have not been documented well. The defendant must present accurate records that show the exact dates that ownership changed in this context.

Seek Legal Help

Medicaid fraud charges are very serious accusations. One should make sure that they seek legal help immediately. The charges rack up huge fines and penalties. That is why they should not be taken lightly. One should seek an experienced Medicaid fraud defense attorney to help them fight the case.

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