Health Care Fraud is a crime in which health providers knowingly and intentionally submit false and misleading information to government programs, such as Medicare and Medicaid, for reimbursements. In New York, fraudulent providers may be charged with a misdemeanor or felony for Health Care Fraud.

The Office of Inspector General (OIG) of the U.S. Department of Health & Human Services (HHS) conducts investigations and audits health practitioners for fraudulent and abusive activities to Medicare, Medicaid and other government health programs.

According to OIG compliance guidelines, physicians may be subject to audit or investigation when the government is suspicious of fraudulent billing practices. These practices include

• submitting claims for services not performed
• submitting claims for medical equipment that are unnecessary
• double billing
• billing for noncovered services as covered
• Using another provider’s identification number
• Billing for unbundled services
• Consistent improper use of procedure code and upcoding level of services
• Clustering

In the beginning of an investigation, the government will request documents such as patients’ medical charts and financial records to check for accuracy and appropriateness in submitting claims. This is a voluntarily request and physicians are absolutely not obligated to disclose such information. Some physicians who blindly comply will submit requested information, which in turn, will potentially harm them.

The best advice is to speak with an experienced health professional defense lawyer to personally evaluate your case and build an aggressive defense strategy for you.

If you believe that you are being investigated for Health Care Fraud in New York and New Jersey, then call our office at (212) 577-6677 for immediate consultation.

Yes, even if the two separate charges are stemmed from the same illegal act, a defendant can be charged with both crimes. One of the primary examples would be the illegal act of committing Medicaid recipient fraud, which dates the crime back to the application process.

Recipients who are charged with Medicaid fraud are usually unaware that they were committing a crime. In such cases, insurance representatives are usually the ones who submit the applications for recipients. Despite the fact that many of these recipients do not qualify for Medicaid, by residency or by income, representatives submit their altered applications anyways.

Without reading or just skimming through the Medicaid qualification provisions and the application, recipients just sign their names on the dotted line, which ultimately transfers the representative’s criminal liability to the recipient.

Everybody is doing it anyways,

It is true that within New York City there is many people who are clearly unqualified for Medicaid still apply for and fraudulently receive Medicaid. But it does not mean that they are safe from the Human Resource Administration’s (HRA) Medicaid investigators. The Bureau of Fraud Investigation (BFI) team routinely runs through every Medicaid application; the system targets residency first, then income.

The system may be slow because of the millions of applications, but it will eventually get through each applicant. It is not rare to see a recipient get prosecuted for welfare fraud and insurance fraud after being investigated by BFI, but the process often takes time, which gives the recipient time to pay back the misapplied claims, cancel his/her Medicaid and have the case dropped.

Of course every criminal case is different and it depends on the facts of case, but it is advised that when you are contacted by the BFI either by a letter or a home visit, you should call an experienced criminal defense attorney right away.

If you have been investigated by for Medicaid Fraud in New York, call our New York Medicaid Fraud Defense Attorneys at (212) 577-6677 to get professional legal advice.

The crime of aiding and abetting a criminal act, or more specifically Medicaid Fraud is considered to be a “secondary” criminal liability. To aid and abet Medicaid fraud is to knowingly assist another in committing the fraud, which renders the perpetrator guilty of misconduct.

Is the crime of aiding and abetting Medicaid Fraud the same as the crime of conspiracy to defraud Medicaid?

No. Conspiracy and aiding and abetting liabilities are similar in that both involve the participation of multiple defendants in the furtherance of a criminal act, such as Medicaid fraud. However, conspiracy is generally broader in definition, which permits New York State and federal prosecutors greater flexibility in prosecution multiple defendants and in the presentation of evidence.

But to prove an aiding and abetting violation, the prosecutor must show:

• A primary violation of the penal laws by another
• That the aider or abettor had knowledge of the primary fraudulent act
• That the aider or abettor rendered substantial assistance to the primary defendant in furtherance of committing Medicaid fraud.

Despite the similarities, the crime of aiding and abetting in Medicaid fraud does not encompass as severe criminal liabilities as conspiring to defraud Medicaid, which can render the conspirator up to five years of incarceration.

It is advisable that at the onset of a Medicaid fraud investigation you should call a skillful and experienced New York City criminal defense attorney before speaking with the investigator. Even when the investigator has gather enough evidence before speaking to you to charge you of aiding and abetting Medicaid fraud, they can use your incriminating testimonies as further evidence to raise the charges to conspiracy to defraud Medicaid.

If you are investigated for or charged with Aiding and Abetting Medicaid Fraud or Conspiracy to defraud Medicaid in New York City, then call our office at (212) 577-6677 to get professional legal advice.

After a recent lawsuit filed by the federal government against New York State for Medicaid Fraud, New York State has begun to tighten its provisions on what is covered by Medicaid, particularly in the division of long/short term personal care services for the elderly and/or disabled.

With considerable cutbacks in New York City’s 1199 SEIU program, the Human Resources Administration is looking over certain sectors with a fine toothcomb. Nursing home workers, and home care workers are not only being cut back, but sister homecare programs that work in collaboration with Medicaid (Medicaid providers) are also facing allegations of overbilling and Medicaid Fraud.

The Medicaid Inspector General (OMIG) includes most of these Medicaid providers in civil fraud suits for engaging in fraudulent activities. Reviews of the provider billings are the first approach OMIG investigators take. By “following the money”, the billings would lead investigators back to the provider and the company’s biller.

When you become aware of an ongoing Medicaid fraud investigation by the OMIG, do not take matters into your own hands; call an experienced and skillful New York criminal defense attorney to assess your case to optimize your defense.

At Joseph Potashnik & Associates, we have a panel of some of the most skilled New York State criminal defense attorneys specializing in various areas of white-collar crime defenses.

If you are being investigated or arrested for a Medicaid fraud charges in New York, then call our office at (212) 577-6677 to get professional legal advice.

Yes, but the differences between these two concepts are generally not grand in definition. It depends on how one looks at the question and the subsequent criminal case that applies to it. When an investigation target waives his Miranda rights, he waives his Fifth Amendment right to remain silent.

When the investigator asks the target a question after the waiver and he answers, the statement the target makes is voluntary and can be used as admissible evidence against him. The option to waive the target’s own Miranda Rights generally happen after an arrest, and during police interrogation.

Often at times, offenders get mistaken that a voluntary statement is the same as a voluntary Miranda Rights waiver, and it affects the likelihood of criminal prosecution in a case.

For example, in most New York City Medicaid Recipient Fraud cases, a Medicaid beneficiary would receive a letter from a Bureau of Fraud Investigation (BFI) that requests consecutive tax return papers, bank account information and deed to a certain property. Often at times, the letter would also include an interview date that requests the beneficiary’s attendance to investigate on the his eligibility and possibly Medicaid fraud.

Even though this is not recommended, the beneficiary attends the interview and offers all the information the investigator has asked for. In this situation, the Medicaid Fraud investigator is not required to give the beneficiary the option of waiving his/her Miranda rights. Why? Because the interview is voluntary, and that the beneficiary is not arrested or is not held in custody. Therefore, the statements and information the alleged beneficiary submits becomes voluntary statements, which can be used as admissible evidence against the beneficiary.

The difference between a voluntary statement and a voluntary Miranda Rights waiver may be marginal, but it is essential for the alleged offender to know these differences. A mere fraction of not knowing or not finding out can make or break one’s case.

If you are being investigated or arrested for a crime in New York, then call our office at (212) 577-6677 to get professional legal advice.

The Human Resource Administration, Division of Claims and Collections, formerly known as the Bank Match team are responsible for matching your bank accounts that have assets in excess of Medicaid eligibility limits, which were not declared on your Medicaid application or renewal. Hiding your bank accounts to make you seem eligible for a level of Medicaid that you would not have receive otherwise is a form of Medicaid fraud.

As of current, Medicaid has raised the yearly income and resource level, which allowed many beneficiaries to have more assets in their bank accounts than the previous years. However, this recent change does not prevent Medicaid fraud investigators from opening a file against you. Investigators are allowed to look back five years to when the law did not change, and find out whether you applied for Medicaid with assets in excess of the Medicaid guidelines at the time.

For most of these cases, the New York City Department of Social Services (NYC DSS) may be just looking to get back the claims that were incorrectly paid on your behalf. Investigators from the Division of Claims and Collections are not trying to put you in prison; they tend to refer cases to the HRA legal department to bring civil suits rather than criminal suits.

Do Not Be Mistaken

The HRA, Division of Claims and Collections is not the same as the Bureau of Fraud Investigation (BFI).  BFI investigators tend to focus more on the offender’s residence, income, property owned etc. They are also required to refer a certain number of cases to the New York State District Attorney’s Offices for criminal prosecution.

In some cases, assets that Medicaid investigators deemed as excess of Medicaid eligibility limits may actually fall within Medicaid’s exceptions such as a burial account.

After you receive a letter from the HRA, it is advisable to contact an experienced Medicaid fraud attorney as quickly as possible to minimize damages.

If you are being investigated or arrested for Medicaid fraud in New York, then call our office at (212) 577-6677 to get professional legal advice.

There are two categories of people who are investigated and prosecuted for Medicaid fraud: beneficiary recipients and health care providers. Although both forms of Medicaid fraud are strictly investigated, in most cases, Medicaid providers are faced with more disciplinary actions: criminal and administrative.

The predominant crime Medicaid providers are charged with is larceny perpetuated by the submission of false Medicaid claims for services or supplies not provided, or in other words, Medicaid fraud.

There are many forms of Medicaid fraud, such as billing Medicaid twice (or more) for the same services or supplies, billing for procedures that are not a medical necessity and billing under the physician’s code for services provided by a nonprofessional.

In most cases, a provider charged with Medicaid fraud is usually charged with another crime such as larceny by false pretense, offering a false instrument for filing, falsifying business records, grand larceny etc.

Criminal penalties for Medicaid fraud are typically serious. But depending on the amount of money stolen, a Medicaid provider may face imprisonment from 1 year to 25 years, if convicted.

In a sentence, a physician Medicaid provider convicted of a crime, will most likely be further investigated by various New York State boards for de-licensure, suspension from practicing the profession and expulsion form various public and private programs, especially Medicaid.

A criminal conviction is extremely detrimental to a provider’s medical career because the board’s investigations and actions rely on the same facts that resulted in the criminal conviction.

If you become aware that you are under investigation for Medicaid fraud in New York, contact our New York State criminal and administrative defense attorneys to discuss your case at (212) 577-6677, before taking another step.

After major changes in the Social Service Law on January 1, 2010, there is no more “resource test” for Family Health Plus and non-SSI-related Medicaid programs. This means that applicants’ resources such as real estate and cash will not be considered in determining eligibility. Also, resources are not considered for pregnant women and infants under one year of age and for children over age one but under age 19 if income is at or below the appropriate poverty level.

Income will continue to be the main determination of eligibility for Medicaid in New York. With the new law, the general amount of recipient Medicaid fraud cases investigated by the HRA has decreased compared to the last few years when a large number of investigations involved Medicaid recipients with multiple properties. However, making false statements on a New York City Medicaid or Family Health Plus application regarding the income, family size, and permanent address could still result in criminal prosecution.

If you are investigated for Medicaid Fraud in NYC, call us at 212-577-6677

Deborah Kantor, the owner and operator of H.I.S Holdings, Inc. a debt collection agency that mostly services to New York hospitals, pleaded guilty to one count of Bribery and three counts of Rewarding Official Misconduct for bribing a hospital social worker in exchange for Medicaid client identification numbers and his approval of incomplete or falsified Medicaid applications.

Her company, H.I.S Holdings also entered a guilty plea to one count of Bribery. The company faces a fine of $10,000.

Between 2000 and 2007, Kantor had paid more than $17,749 to a hospital social worker named Michael Albrecht and an additional $50 for each active Medicaid client identification number provided. By obtaining the beneficiaries’ identification numbers, Kantor can allegedly enable them to receive Medicaid reimbursements for various hospital claims. Kantor allegedly received a total of $725,000 from a contingency of the fraudulent reimbursements.

In January 2010, Kantor and another co-defendant, Amy Gardner, were additionally convicted by a Niagara County jury for filing a false Medicaid application.

If convicted, Kantor faces a maximum penalty of 7 years in prison.

Anne Salvant and Michelle Timothee, a New York licensed practical nurse and her patient’s mother consecutively, were both arrested and charged with Grand Larceny in the Third Degree, for defrauding the New York Medicaid program of over $32,000. Salvant was additionally charged with 3 counts of Offering a False Instrument for Filing in the First Degree and Falsifying Business Records in the First Degree.

Between October 2007 and May 2010, Salvant and Timonthee had allegedly conspired and acted on a scheme to defraud Medicaid. Salvant, a New York State licensed practical nurse who was assigned to care for Timonthee’s disabled son, has been purportedly submitting falsified nurses’ notes and time sheets to Accucare Nursing and Homecare to bill for her “work”.

However, investigations on Salvant revealed undercover video surveillance of Salvant’s absence from Timonthee’s home for the hours she billed Medicaid.  Timonthee purportedly received a portion of Medicaid’s payment for her participation in Salvant’s scheme.

If convicted of all the charged counts, Salvant and Timonthee face more than 5 years in prison