Last Updated on: 15th October 2023, 07:49 am

Westchester Medicaid Fraud Lawyer – A Helpful Guide for the Community

Medicaid fraud is a big problem here in Westchester County, New York. As a community, we need to work together to stop it. That starts with understanding what Medicaid fraud is, how it happens, and what to do if you suspect it. This article aims to be a helpful resource for our community on this important issue.

First off, what exactly is Medicaid fraud? Basically, it’s when someone lies or withholds information to get Medicaid benefits they don’t deserve. This could be a healthcare provider billing for services that were never provided. Or it could be an individual failing to report income so they qualify for Medicaid when they make too much money.

Medicaid fraud steals money meant to help vulnerable community members get healthcare. And we all pay for it through taxes. So it’s a big deal! Thankfully, there are resources to report suspected fraud in Westchester County.

How to Spot Potential Medicaid Fraud

Many times, Medicaid fraud involves healthcare providers like doctors, dentists, or medical transport companies. Here are some red flags to watch out for:

• Billing for services not performed – This is a big one. If you’re billed for an appointment or procedure you never had, something fishy is going on.
• Upcoding – When a healthcare provider bills Medicaid for more expensive services than were actually provided.
• Excessive services – Billing an unreasonable number of procedures or tests, especially compared to peers.
• Fake diagnoses – Billing for treatments related to conditions the patient doesn’t actually have.
• Kickbacks – Doctors referring patients to other providers in exchange for money.

For individuals, signs of potential Medicaid fraud include:

• Failing to report income or assets – This allows people to qualify for Medicaid who otherwise wouldn’t.
• Using someone else’s Medicaid card – Letting a friend or relative use your Medicaid benefits.
• Selling prescription drugs – Illegally selling drugs obtained through Medicaid.

If you see any sketchy behavior like this, it may be Medicaid fraud. Report it right away.

Reporting Suspected Medicaid Fraud in Westchester County

If you suspect Medicaid fraud, there are a few ways to report it in our county:

• New York State Office of the Medicaid Inspector General (OMIG) – This office investigates fraud and abuse in the Medicaid program. You can report suspicions through their online complaint form or by calling 877-87FRAUD.
• NYS Attorney General’s Medicaid Fraud Control Unit – Part of the AG’s office that prosecutes Medicaid fraud cases. Reports can be made by phone at 212-417-5397 or through an online complaint form.
• Westchester County Department of Social Services – Call 914-995-3333 or visit a local DSS office to report Medicaid fraud suspicions.

The more details you can provide, the better. Things like patient names, dates of services, and specific billing issues help investigators follow up. And you can report anonymously if you prefer.

What Happens After Reporting Medicaid Fraud

So what happens after you report suspected Medicaid fraud? Basically, the agency you contacted will look into it to determine if fraud is actually occurring. Here’s a quick rundown of next steps:

• Investigation – Investigators interview witnesses, gather records, and review billing data to build a case.
• Payback Demands – If fraud is confirmed, the provider or individual may have to repay Medicaid funds.
• Fines & Penalties – Large fines are common punishments for Medicaid fraud.
• Criminal Charges – Fraud can lead to felony criminal charges, including jail time.
• Exclusion from Medicaid – Providers can be banned from billing Medicaid in the future.

The bottom line is Medicaid fraud is taken very seriously. And reporting it helps protect our community’s resources for those in need.

Finding a Medicaid Fraud Lawyer in Westchester County

If you’re being investigated for or charged with Medicaid fraud, it’s essential to speak with an experienced lawyer right away. An attorney can help protect your rights and build the strongest defense.

When choosing a Medicaid fraud lawyer, look for these important qualifications:

• Knowledge of New York healthcare laws – Medicaid rules can be complex, so you need an attorney well-versed in NY regulations.
• Fraud investigation experience – Have they handled Medicaid fraud cases previously? Ask about their track record.
• Trial skills – In case your charges go to court, your lawyer should have litigation experience.
• Negotiation ability – They’ll need to negotiate with investigators or prosecutors for a favorable outcome.

Also consider lawyers located right here in Westchester County. They’ll know all the local prosecutors and processes best.

Here are some top Medicaid fraud law firms to consider in Westchester:

• Pappalardo Law – White Plains firm with extensive healthcare and Medicaid fraud experience. Call 914-946-7432.
• The Quinn Law Firm – Based in White Plains and Mount Kisco. Proven record defending Medicaid fraud. 914-220-5800.
• Gleason & Koatz LLP – Seasoned Westchester firm handling many types of fraud cases. 914-946-5200.

And the Westchester Public Defender’s office may be able to provide legal help if you can’t afford a private attorney. Call 914-995-3270.

Possible Defenses Against Medicaid Fraud Charges

If you’re accused of Medicaid fraud, all hope is not lost. There are often strong defenses an experienced attorney can use to fight the allegations. Some potential defenses include:

• Lack of intent – Prosecutors must prove you knowingly and intentionally committed fraud. If it was an honest mistake, that’s a defense.
• Improper procedures – If investigators didn’t follow proper protocols, evidence could be suppressed.
• Unqualified expert witness – A fraud expert used by the state may not actually be qualified to testify.
• Statute of limitations expired – There’s a time limit for the state to charge you after an alleged offense.

An attorney knows how to assert these defenses skillfully to undermine the prosecutor’s case against you. Don’t go it alone if accused of Medicaid fraud.

Potential Penalties for Medicaid Fraud Convictions

If convicted of Medicaid fraud in New York, possible penalties include:

• Up to 4 years in state prison for felony fraud
• Fines equal to 2 to 3 times the amount stolen
• Restitution to repay Medicaid funds obtained illegally
• Loss of professional license for healthcare providers
• Exclusion from future Medicaid participation

That’s why building an aggressive defense is so important if facing charges. An experienced fraud lawyer can sometimes get charges reduced or even dismissed. Don’t wait to seek help.

Let’s Work Together to Stop Medicaid Fraud

Medicaid fraud drains precious resources meant for the most vulnerable in our community. We all have a role to play in stopping it through awareness and reporting suspicions. But those accused also deserve strong legal advocacy. This article aimed to provide helpful guidance on the Medicaid fraud issue. Let’s keep working together, Westchester County, to tackle this problem head on.

Sources

• Westchester Ringleader Of $8M Medicaid Fraud Scheme Gets 95 Months
• Manhattan U.S. Attorney Announces $7 Million Civil Fraud Settlement With Westchester County Hospital
• Manhattan U.S. Attorney Settles Civil Fraud Claims Against Westchester Medical Center
• Attorney General James Sues Owners and Operators of Four Nursing Homes for Financial Fraud and Resident Neglect
• New York Medicaid Fraud | NY Crime Defense Lawyer
• Westchester Criminal Attorneys for Healthcare and Medical Fraud