Medicaid Fraud Attorney in New York

Medicaid Overview

Medicaid is a federal public health insurance program which encompasses many unique benefits and services which vary from state to state. Medicaid and its general guidelines are established by the federal government and specific eligibility and funding provisions are provided by the legislature of each individual state in the nation.

Medicaid is considered by many to be a vital resource for aging Americans across the country because of the many ways its programs, benefits, and forms of assistance can help to stabilize and even improve quality of life. For these reasons claims of fraud are common and sometimes unfounded.

We Set the Bar Others Strive to Reach

If you have been accused of Medicaid fraud, contact the Law Offices of Robert Tsigler, PLLC for a free consultation with a New York fraud defense attorney who can assist you.

Medicaid Fraud in New York

Due to the vast sums of money encompassed throughout the Medicaid program, there are many unique methods utilized to defraud individuals, organizations, and the state of New York. Broadly speaking, all of these may fall within the realm of healthcare fraud though there are many unique statutes and laws which determine how Medicaid fraud is prosecuted.

The following is a general overview of various types of Medicaid fraud:

  • Medicaid Front Organizations: Businesses established for the sole purposes of improperly gathering Medicaid funds
  • Improper Billing Practices: Knowingly billing for services which may not actually be rendered but which are covered by various Medicaid programs or funding mechanisms
  • Illegal Prescription Drug Sales
  • Duplicate Billing Practices: Knowingly charging both Medicaid and private insurers for healthcare services rendered
  • Overbilling for Services: Knowingly inflating the cost of procedures so as to defraud the New York Medicaid program

Schedule Your Free Consultation

The Law Offices of Robert Tsigler, PLLC can assist you in defending a Medicaid fraud charge. Our New York criminal defense lawyer is available to assist you 24 hours a day, 7 days a week.

Schedule your free consultation by calling (718) 878-3781.

Having a good lawyer can be the difference between getting a long prison sentence and avoiding a long prison sentence. A good lawyer will do their best to make sure you get a fair trial and are treated well in the court room. In this article, I’m going to tell you what Medicaid fraud is and make you aware of the potential punishments of committing Medicaid fraud.

What Is Medicaid Fraud? 

To start, Medicaid is a health plan that provides a variety of health care services to people. Medicaid fraud is when someone provides false information to have their medical expenses paid through Medicaid. This is done in many ways including retention of over payments, ghost patients, false certification and red-lining. Retention of over payments is when Medicaid gives someone more money than they were supposed to and the person keeps the money. Instead of keeping the money, the person should return the amount that they were over paid within 60 days of receiving the money. Ghost patients are people who are receiving Medicaid funding but do not actually exist. They were instead fraudulently created just to abuse the Medicaid system. False certification is when someone provides fake certificates to receive Medicaid funding. Red-lining is done by a Medicaid company and it is when a company discriminates against a patient because they feel that they can save money by not treating them, The company then keeps the money for itself.

First-Degree Medicaid Fraud

First-degree Medicaid fraud is when someone knowingly and willingly provides false information to get the benefits of a Medicaid health care plan and the total value of the benefits exceeds $1,000,000. First degree Medicaid fraud is a class B felony.

Second-Degree Medicaid Fraud

Second-Degree Medicaid fraud is when someone knowingly and willingly provides false information to get the benefits of a Medicaid health care plan and the total value of the benefits is between $50,000 and $999,999. Second-degree Medicaid fraud is a class C felony.

Third-Degree Medicaid Fraud 

Third-degree Medicaid fraud is when someone knowingly and willingly provides false information to get the benefits of a Medicaid health care plan and the total value of the benefits is between $10,000 and $49,999. Third-degree Medicaid fraud is a class D felony.

Fourth-Degree Medicaid Fraud 

Forth-degree Medicaid Fraud is when someone knowingly and willingly provides false information to get the benefits of a Medicaid health care plan and the total value of the benefits is between $3,000 and $9,999. Fourth degree Medicaid fraud is a class E felony.

Fifth-Degree Medicaid Fraud 

Fifth-degree Medicaid fraud is when someone knowingly and willingly provides false information to get the benefits of a Medicaid health care plan and the total value of the benefits does no exceed $2,999. Fifth-degree Medicaid fraud is a class A misdemeanor.

How Is Medicaid Fraud Proven?

If you are ever thought to be committing Medicaid Fraud, you will be put through a thorough background check and asked to provide specific identification to investigators. This will let the investigators know if you have knowingly participated in any form of Medicaid fraud and are receiving any medical benefits that you shouldn’t be. They will know this because, to receive Medicaid, you have to provides certain forms of identification. If there is no record of your identification in the Medicaid system, but they can still prove you have used Medicaid, then you have likely been committing Medicaid fraud.

Do Business With Tsigler Law Today

Throughout this article, I have gone over many different forms of Medicaid fraud and told you exactly what Medicaid fraud is. I have also told you the penalties that come with Medicaid fraud and how Medicaid fraud is proven. Having said that, I would like to thank you for reading this article. If you are facing charges of Medicaid Fraud, then contact Tsigler Law. The people at Tsigler Law are committed to providing their clients with the best services possible and would love to be able to serve you.

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