Medicaid Fraud Defense Law FirmThe Health Department's Office of Medicaid Management and New York City Human Resources review Medicaid recipient utilization and investigate other charges of fraudulent behavior in order to take action against them. Some types of fraud may be referred to other government authorities including the Criminal Court. The Storobin Law Firm has been handling Medicaid fraud investigations by Human Resources and prosecutions in criminal court for over a decade, and we now have the largest Medicaid Fraud defense practice in New York. We know the investigators, their supervisors, procedures and the proper way to protect you from criminal charges, permit/license losses (which can happen to attorneys, nurses and others), fines and all other types of penalties. When the government demands a repayment of any amount they spent, we routinely save our clients an additional 25%-60%, and sometimes more, in addition to eliminating fines and penalties. We are also usually able to work out an interest-free payment plan to make restitution more affordable. Furthermore, our clients receive a letter stating that restitution does not constitute an admission of wrong-doing and that the matter will not be referred to a court, credit agency or anyone else. In other cases, we are able to show that our clients were eligible to receive Medicaid and therefore should not have to pay back anything. We know the rules and the laws, and we know how to protect your interests. Hiring the right law firm can make a difference of tens of thousands of dollars for you, and even be the difference between having a criminal record and not having one. If you are being investigated for Medicaid fraud, you need to call us at (646) 646-0601.
Why should you hire us as your law firm?
- Our attorneys were praised by the media, judges, attorneys and of course, our clients. They were called "global legal expert","an asset to the legal profession" and "highly respected by the legal community". (Learn more about our attorneys.)
- Our lawyers understand potential criminal and civil penalties of your Medicaid investigation.
- We keep up to date on the latest developments with advanced attorney courses.
- Personal attention and dedication to every client, every time.
- Pay an affordable flat fee of $2,750.
Call our attorneys at (646) 350-0601.
Medicaid Recipient Fraud
A Medicaid recipient may be Medicaid fraud investigation as well as criminal charges due to any of the following:
- Stating false facts on the application to receive Medicaid despite being ineligible;
- Loaning Medicaid to another person;
- Forging or altering a prescription or fiscal order;
- Using multiple Medicaid cards;
- Intentionally receiving duplicative, excessive, contraindicated or conflicting health care services or supplies; and
- Re-selling items provided by the Medicaid program.
If you are the recipient of a target letter from an investigator at the Bureau of Fraud Investigators at the Human Resources Administration ("HRA") for potential fraud this means that you have come on to one of the many Investigators radars for some reason. This could be for any of the following:
- Your name appears on the deed to real estate either in New York State or outside of New York State
- Your name appears on the title to a car or multiple cars
- Your children go to private school
- Your employer has reported your income that affects your eligibility
- You have bank accounts, stocks, bonds, 401K or other investment assets that affect your eligibility
- Another individual has reported you for fraud
If the case has started off at this level, the first letter that you will receive will be from the Investigation Revenue and Enforcement Administration Bureau of Fraud Investigation.
The letter will state that Bureau of Fraud Investigation office is conducting an investigation into your eligibility for Medicaid and that an interview has been scheduled for you to come down to their offices to discuss this matter. The target fails to tell you that if during their investigation it is apparent that there is criminal culpability they will likely refer the case out to the local District Attorneys office for prosecution or that if the civil liability is clear they might refer the case out to one of the law firms that represents the city in these matters. Either way, what you say and do will be held against you in court. The ideal situation for the HRA investigators is that you come down to the scheduled meeting, disclose everything and then they demand an inordinate amount of money from you and you are left with few options. The letter itself itself will give you a good idea of the type of evidence that they already have against you.
The letter will ask for the following documents when you come down for their meeting.
- Photo ID, and a copy of the target letter
- Business bank book for the years under investigation
- Personal bank book for the years under investigation
- Drivers license
- Income tax documentation for the business for the years under investigation
- Income tax documentation for your personal returns for the years under investigation
- Last 4 pay-stubs
- Pension/401K/IRA Statements
- Utility bills
- Cell phone bills
- Business records
- Dissolution records
- Letter certifying where your children attend school
Medicaid/Medicare Provider (Medical Office) Fraud
* Billing for services that were not provided, e.g., a chest x-ray that was not taken.
* Duplicate billing which occurs when a provider bills Medicaid and also bills private insurance and/or the recipient.
* Requiring the recipient to return to the office for more visits when another appointment is not necessary.
* Taking unnecessary x-rays, blood work, etc.
* Upcoding, e.g., providing a simple office visit and billing for a comprehensive visit.
* Having an unlicensed person perform services that only a licensed professional should render, and bills as if the professional provided the service.
* Billing for more time than actually provided, i.e., counseling, anesthesia, etc.
* Billing for an office visit when there was none, or adding additional family members' names to bills.
* Accepting payment from another provider, including sharing in the reimbursement paid by the Medicaid program, as a result of referring a patient to the other provider.