New York Medicaid Fraud Defense

Experienced New York Medicaid Fraud Defense Counsel for Health Care Providers and Other Targets

New York has become one of the primary battlegrounds in the government’s fight against Medicaid fraud. Physicians, pharmacies, hospitals, nursing homes, and other providers are all at risk of facing scrutiny—and this scrutiny can lead to civil or criminal allegations.

Health care providers that bill New York’s Medicaid program are facing intensive scrutiny. Due to allegations of widespread fraud, this has become a priority enforcement area at the state and federal levels. Nursing homes and other providers are facing scrutiny as well—as are other entities and individuals suspected of paying (or receiving) illegal kickbacks and submitting fraudulent claims for reimbursement.

Our New York Medicaid fraud lawyers represent targeted entities and individuals statewide. We defend clients that are facing both civil liability and criminal prosecution. With the government’s focus on Medicaid fraud enforcement, facing criminal charges is a very real concern—particularly at the federal level. Regardless of the nature of allegations at hand, our lawyers can use their experience to target a favorable resolution that avoids unnecessary consequences.

Common Health Care Fraud Allegations Under Medicaid

Health care fraud allegations under Medicaid can take many different forms. Auditors and investigators are scrutinizing providers’ billings for any indication that their program billings may not comply with the law. Some examples of common allegations resulting from Medicaid audits and Medicaid fraud investigations in New York include:

• Upcoding, unbundling, and other fraudulent billing practices under Medicaid
• Providing (and billing Medicaid for) unnecessary tests and medical treatment
• Billing Medicaid for treatment provided by individuals who do not have a medical license
• Billing Medicaid for medical equipment purchases that are not eligible for reimbursement
• Improperly billing Medicaid for prescription medications
• Using Medicaid funds to pay unlawful kickbacks or referral fees
• Accepting unlawful kickbacks or referral fees in violation of the Anti-Kickback Statute or Stark Law

At the federal level, Medicaid fraud cases are typically prosecuted under the False Claims Act (FCA). The FCA prohibits the submission of “false or fraudulent claims” under government health care programs, and it includes provisions for both civil and criminal enforcement. In civil enforcement cases, targeted entities and individuals can face recoupments, fines, suspension or exclusion, and other financial and administrative penalties. In criminal enforcement cases, doctors, dentists, pharmacists, and other individuals can face prison time as well.

At the state level, the New York False Claims Act imposes civil fines and liability for treble damages. While the New York False Claims Act does not include criminal enforcement provisions, state prosecutors can pursue fraud charges under the New York State Penal Law when warranted.

We Handle Cases Involving All State and Federal Authorities

Within our Medicaid fraud defense practice, we represent entities and individuals that are facing Medicaid-related scrutiny in New York from all state and federal authorities. This includes representing clients in matters involving:

U.S. Department of Justice (DOJ)

The U.S. Department of Justice (DOJ) has made clear that it is prioritizing Medicaid fraud enforcement. While the DOJ has publicized several large-scale Medicaid fraud crackdowns in recent years, it is also actively targeting individual providers (and other entities and individuals) suspected of defrauding New York’s Medicaid program.

U.S. Department of Health and Human Services Office of Inspector General (HHS OIG)

The U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) shares primary responsibility with the DOJ for Medicaid fraud enforcement at the federal level. HHS OIG routinely conducts investigations targeting providers suspected of submitting fraudulent claims for reimbursement; and, while it has civil and administrative enforcement authority, it works with the DOJ to pursue criminal charges when warranted.

New York Medicaid Fraud Control Unit (MFCU)

New York’s Medicaid Fraud Control Unit (MFCU) has statewide jurisdiction, and it has several regional offices across the state. Approximately 25% of the MFCU’s budget comes from fraud recoveries—so it has a significant financial incentive to impose recoupments and other penalties. Similar to DOJ and HHS OIG investigations, MFCU investigations can lead to either civil or criminal enforcement, and targeted providers can face professional licensing action (among other employment-related consequences) as well.

New York State Office of the Medicaid Inspector General (OMIG)

Along with the DOJ, HHS OIG, and MFCU, the New York State Office of the Medicaid Inspector General (OMIG) also conducts Medicaid fraud investigations through various means—including billing data analysis, surveillance, interviewing, and the issuance of subpoenas for document production. OMIG investigators are typically looking for evidence of deliberate deception in Medicaid fraud cases, though unintentional billing errors can expose targeted providers to significant liability as well.

Other Law Enforcement Agencies

Our New York Medicaid fraud defense lawyers also represent clients that are facing scrutiny from other state and federal law enforcement agencies. This includes (but is not limited to):

• Federal Bureau of Investigation (FBI)
• Internal Revenue Service Criminal Investigation (IRS CI)
• New York Bureau of Criminal Investigation (BCI)

If you, your practice, or your business is facing Medicaid-related scrutiny, you should speak with a lawyer before speaking with auditors or investigators. We can arrange for you to speak with one of our senior lawyers in strict confidence promptly, and we can provide legal representation on an emergency basis if necessary.  

From Long Island to Syracuse, We Handle New York Medicaid Fraud Cases Statewide

We handle New York Medicaid fraud cases statewide. Our lawyers rely on extensive experience—including prior experience as Medicaid fraud prosecutors—to defend clients against all types of fraud-related allegations. We provide legal representation throughout the investigative process; and, while we provide trial representation when necessary, we focus on helping our clients achieve favorable and discrete pre-charge resolutions whenever possible.

We Also Handle Medicare Fraud Investigations and Prosecutions in New York

Along with handling Medicaid fraud investigations and prosecutions in New York, we defend clients that are facing Medicare fraud allegations as well. In many cases, Medicaid fraud and Medicare fraud allegations will go hand-in-hand, and avoiding unnecessary adverse consequences will require a comprehensive and cohesive defense strategy. Our lawyers also have significant experience on both sides of Medicare enforcement matters, and we can use our experience to help protect you by all means available.

FAQs: Defending Against Medicaid Fraud Allegations in New York

Speak with a Senior New York Medicaid Fraud Defense Attorney at Oberheiden P.C.

Our attorneys are available to represent health care providers and other entities and individuals in Medicaid fraud cases nationwide. To speak with a senior New York Medicaid fraud defense attorney at Oberheiden P.C. in strict confidence as soon as possible, call 888-680-1745 or tell us how we can contact you online today.