Medicaid Fraud Lawyers
It can begin when a Medicaid fraud investigator obtains information about a person’s benefits. This information may indicate a person is not qualified for the Medicaid benefits they are receiving or worse. Many times this information is obtained from a variety of records. This includes property records, business records, payroll records and more. A Medicaid fraud investigator may even obtain information about a person from their co-workers or even people living in their neighborhood.
Notification
A person will usually learn they are the subject of a Medicaid fraud investigation after receiving a letter from an investigator. The letter will usually ask the person to produce a number of documents. The investigator will then want to meet with the person for an interview.
Accusations
There are a number of reasons a person may be investigated for Medicaid fraud. The investigator could suspect a person did not tell the truth on their application. This could include information about their income, assets and more. Some people are suspected of reselling the medicine or other products they received through the Medicaid program. Others are accused of forging, altering or receiving duplicated prescriptions. Others may have obtained services they are not eligible to receive. In some cases, people are accused of letting another person use their Medicaid card. There are individuals who are accused of having and using more than one Medicaid card.
Meeting
It’s important that people realize when they get this letter, the investigator has already collected evidence against them. The Medicaid fraud investigator believes the person has broken the law. Anything a person says during their meeting can be used against them in the future. An innocent mistake could result in a person having criminal charges filed against them. People have a right to have an attorney with them during this meeting. An experienced Medicaid fraud attorney should be consulted before anything is said to the Medicaid investigator, or any documents are provided.
Rights
A person has the right to have an attorney present when they meet or speak with the Medicaid fraud investigator. An individual does not have to answer the investigators questions. It is within their rights to say nothing. A person who is being investigated and receives benefits from the Family Health Plus or Medicaid won’t have their benefits canceled simply because they refuse to answer an investigators questions. How a person is advised to approach the situation will depend on the facts of their individual case. An appropriate question, as well as document request, will be addressed. The investigator could also ask questions and have document requests that are improper. In some situations, the best way to handle the situation is to cooperate with the investigator. An experienced attorney will know how to negotiate the best possible result. The goal will always be to protect an individuals rights.
Possible Penalties and Punishments
When a person is guilty of Medicaid fraud, there are a variety of punishments they could receive. A person may have to repay Medicaid for the benefits they received and in some cases, individuals will go to prison. People have also been excluded and disqualified from receiving any Medicaid benefits in the future. Some people have even received civil judgments as well as liens on any real property they own. It’s possible a person’s wages could be garnished or their professional license suspended or terminated. Depending on a person’s immigration status, they could even be deported.
Administrative Disqualification Hearing
In some situations, the government may believe a person has intentionally defrauded Medicaid, but their fraud does not rise to the level of criminal prosecution. The reason for this is the amount of fraud is too small. The case may then be referred to the Office of Administrative Hearings (OAH). This is part of the New York State Department of Social Services (NYSDSS). This is where an administrative disqualification hearing will take place. The purpose of the hearing is to decide if a person intentionally defrauded Medicaid and if they should be disqualified from getting benefits for a period of time or never again.
Hire An Attorney
An experienced lawyer will know what needs to be done in a Medicaid fraud allegation case. If a case isn’t able to be defended, a knowledgeable attorney will know how to reduce a person’s criminal exposure. A lawyer will know how to assemble all of the important information to get their client the best possible outcome. They will know how to work with a specific judge or prosecutor. Most individuals who are prosecuted with Medicaid fraud in a New York court are charged with a felony. A guilty plea will result in a person having a criminal record. An attorney will know how to negotiate with a DA or Judge to have their client plead to a reduced Misdemeanor charge. In some situations, they can also negotiate a plea bargain. This will enable a person to avoid a criminal conviction, as well as a criminal record.