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If you are facing a medicaid fraud investigation in NYC, don't panic. Our office has almost twenty years of experience successfully handling medicaid fraud cases for providers and recipients. There are a multitude of ways to protect yourself. Working with our firm, you will work directly with our Principal attorney and your case will be based on a well thought out strategy and plan.
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What is Medicaid Fraud?
Medicaid Fraud for providers constitutes billing for services not provided, performing unnecessary tests, providing patients with unnecessary referrals, and charging separately for services usually offered at a packaged rate.
Medicaid Fraud by recipient is mainly due to not disclosing correct income, providing incorrect information about your residential address, and receiving Medicaid benefits illegally. If you received a letter from NYC HRA stating that your eligibility for Medicaid health insurance is under review, you are being investigated for Medicaid Fraud.
What should I do if I received a letter from NYC HRA, Bureau of Fraud Investigations (BFI)?
If you received the HRA investigation letter do not consider going there by yourself. Remember that anything you may disclose during the meeting can be used by the investigator against you. When investigators call you in for an interview, they already assume that you have committed Medicaid Fraud. Seek help of an experienced attorney who will represent you in your Medicaid Fraud investigation case and will take the burden off of your shoulders. Call the Law Office of Inna Fershteyn right away (718) 333-1233 before speaking with investigators. We may be able to obtain an administrative resolution for your Medicaid Fraud investigation case before it is referred to the District Attorney's office.
Why was I picked for Medicaid Fraud in nyc?
Most Medicaid Fraud cases in NYC are flagged because of the recipients' failure to disclose the full household income on their application/recertification or failure to update the agency about the increase in income. There are many different databases available to investigations where they can obtain information regarding Medicaid recipient’s income, household structure, and other evidence. If the information you provided on your application/recertification does not match the information listed in those databases, you will become a target of Medicaid Fraud Investigation.
What can be the outcome of this Medicaid Fraud Investigation?
If you are investigated for Medicaid Fraud, you can face a number of legal consequences including:
- Monetary fines, penalties, and restitution orders
- Disqualification from receiving Medicaid benefits
- Civil judgments and liens on any real property you own
- Garnishment of your wages
- Criminal prosecutions and a possible prison sentence
- Suspension or loss of professional licenses
- Exclusion from participating in Medicaid as a provider
- Depending on your immigration status, you could be deported.
6 Common Medicaid Fraud Schemes by Healthcare Providers
Whether it's accidental or intentional, it is easy for healthcare providers to engage in common healthcare fraud schemes. Below are some common Medicaid fraud schemes.
1. BILLING FOR NON-RENDERED SERVICES
In many cases, healthcare providers, bill for services that were never provided and the corresponding patient files have no evidence or information regarding such documented services. Healthcare providers often provide excuses, but these excuses do not help their case.
2. INCORRECT RECORDING OF PROCEDURES
In this healthcare scheme, healthcare providers list an incorrect diagnosis or procedure that was performed on a patient. This may include admitting patients for unnecessary hospitalizations.
3. UNNECESSARY ISSUANCE OF PRESCRIPTION DRUGS
Patients are sometimes given prescribed medication for reasons beyond the physician's intentions. Similarly, some physicians issue prescription drugs for patients for their personal gain.
4. OVERUTILIZATION OF SERVICES
This typically involves billing for services that are not necessary to perform at all. This may include unnecessary blood tests or physical examinations that the patient receives despite having overall good health.
5. MISREPRESENTING DATES OF SERVICE
Healthcare providers may try to make more money by documenting the same patient on two different days. This may happen since each office visit to the physician is considered a separate billable service.
Providers have been known to receive money for referrals. Consequently, many physicians have abused this power through referring patients to unnecessary services such as MRIs or X-rays
Always work with a qualified NYC medicaid fraud attorney. Our law firm can help you to avoid such harsh consequences and minimize the restitutions payments.
What We Can Do:
- Evaluate the case and your eligibility status
- Achieve an administrative resolution for your case
- Protect and represent you in your Medicaid Fraud investigation case
- Act as a mediator between you and the city attorney instead of an HR investigator
- Plead for hearings and negotiate for smaller restitution payment