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What is Medicaid Fraud?

Today, there are over 5.3 million New York residents enrolled in the Medicaid program, according to the New York State Department of Health. As one of the largest state and federally funded programs, both New York State and the federal government have devoted millions of dollars to investigate, penalize and prosecute individuals and entities engaging in Medicaid fraud.

There are several types of Medicaid fraud, such as those who receive Medicaid fraudulently. Medicaid recipient fraud may include an applicant falsifying information on the application and certification failure to disclose information about income and assets owned, and the failure to disclose income earned by a spouse or other household member. Other activities that can be deemed as Medicaid fraud are loaning another person their Medicaid identification card, changing or creating a falsified order or prescription, using more than one Medicaid identification card, deliberately receiving excess, duplicative or conflicting medical service and/or supplies, and selling Medicaid-provided supplies to others.

However, there are some instances that may trigger an investigation into Medicaid fraud, even if the individual has not acted outside the scope of the law. These instances may include an unusually high frequency of Medicaid claims, an anonymous call to the Medicaid fraud hotline, and a computer-generated analysis of Medicaid claims and billing codes. Medicaid can also perform an investigation if Medicaid benefits were paid incorrectly, even if you are not at fault.

On the federal level, Medicaid fraud is investigated by the Inspector General, the Federal Bureau of Investigation or other federal entities. On the state level, it is investigated by The Medicaid Control Unit of the New York Attorney General’s Office, the Office of Medicaid Inspector General, and local district attorneys. On the local level, it is investigated by the NYC Human Resources Administration or County Department of Social Services. Medicaid fraud can result in a variety of penalties and consequences, from repayment of Medicaid benefits to lengthy prison sentences. Due to the potentially severe consequences an individual can face, it is important that anyone under investigation for Medicaid fraud contact an experienced New York Medicaid fraud lawyer who can advise you of your legal rights and course of action.

The experienced New York Medicaid fraud defense attorneys at the Law Offices of Tanya Hobson-Williams have successfully defended clients who were accused of Medicaid fraud. Our lawyers are knowledgeable in the laws of Medicaid eligibility and usage and will vigorously defend your rights. To schedule a consultation, call 1-866-825-1LAW.