Long Island Medicaid Fraud Attorneys
Long Island Medicaid Fraud
Team Lead
Contact Nick405 RXR Plaza Suite 405
Uniondale, NY 11556
516-217-0967
Any healthcare professional on Long Island who takes patients on Medicaid can face allegations of defrauding the health care system. Charges of Medicaid fraud, or even the suspicion that you or your healthcare company is committing it, can be devastating. Not only are prison time and criminal fines on the table; program exclusion can cripple your business or professional future.
Vigorously defending against a claim of Medicaid fraud is crucial.
The Medicaid fraud defense team at the national law firm Oberheiden P.C. has helped numerous clients on Long Island, New York – both individuals and businesses – fight back against allegations that they have defrauded Medicaid, protected their license to practice, and avoided criminal, civil, and administrative liability for groundless accusations.
What is Medicaid Fraud?
Medicaid fraud is any attempt to obtain money that you are not lawfully entitled to receive from the federal health insurance program Medicaid. According to the Centers for Medicare and Medicaid Services (CMS), of the $800 billion paid out by Medicaid every year to subsidize healthcare for qualifying patients, over 20 percent is fraudulently obtained. Unlawfully getting money from the program can happen in a huge variety of ways, and nefarious actors are finding new ones every year. However, some of the most common ways to defraud Medicaid are:
- Upcoding: By providing one service but then billing Medicaid for a similar, but more expensive one, healthcare providers can receive more compensation for their services than they are entitled to receive
- Unbundling: Many healthcare services that are commonly and easily provided together are bundled with each other in the bills that are sent to Medicaid. However, if they are separated and billed individually, health care providers can make more money for providing the same services
- Billing for services not provided: The most blatant example of healthcare fraud is simply sending Medicaid bills for healthcare services that were not provided. There are plenty of stories of healthcare professionals billing Medicaid for providing more than 24 hours of healthcare services in a single day or for helping patients that they did not actually see
- Providing medically unnecessary care: A particularly tricky example of Medicaid fraud is for providing a Medicaid patient healthcare that they do not actually need. These allegations are difficult to challenge and are extremely frustrating for healthcare professionals because it is often debatable whether the care is necessary or not
- Inadequate documentation: Medicaid requires healthcare professionals and providers to keep extensive documentation of the care that they offer to patients, in large part so that regulators can detect fraudulent activity. Failing to keep that documentation can lead to legal trouble, even if you did not commit fraud
- Drug diversion: Writing false or unnecessary prescriptions for controlled substances can violate several laws, including the Controlled Substances Act. If the prescriptions are paid for by Medicaid, it can also lead to charges of Medicaid fraud
- Kickbacks: Giving or receiving Medicaid money for referring patients to specific doctors or healthcare professionals can violate several federal anti-kickback laws
If you or your Long Island healthcare company is under Medicaid fraud investigation for any of these violations, you need effective legal representation from a New York Medicaid lawyer.
Founder Attorney-at-Law Former DOJ Trial Attorney Partner Former U.S. Attorney 55th Speaker, U.S. House of Representatives (ret.) Government Consultant Of Counsel Former U.S. Secretary of State Former Senior DOJ Trial Attorney Federal Appeals Attorney Former Prosecutor Former Special Agent (DOJ) Former Special Agent (FBI & IRS-CI) Former Supervisory Special Agent (DOD-OIG) Former Supervisory Special Agent (FBI)Put our highly experienced team on your side
Dr. Nick Oberheiden
Lynette S. Byrd
Brian J. Kuester
Hon. Kevin McCarthy
Mike Pompeo
John W. Sellers
Linda Julin McNamara
Nicholas B. Johnson
Roger Bach
Chris J. Quick
Michael S. Koslow
Ray Yuen
Who Prosecutes It?
Because it implicates a federal source of funding, Medicaid fraud falls under the jurisdiction of federal law enforcement agencies. Depending on the nature of the healthcare fraud allegations, your case could be prosecuted by the:
- U.S. Drug Enforcement Administration (DEA)
- Centers for Medicare and Medicaid Services (CMS)
- Department of Justice (DOJ)
- Federal Bureau of Investigation (FBI)
- Medicaid Fraud Control Unit (MCFU) at the Department of Health and Human Services: Office of Inspector General (OIG-HHS)
It is also not uncommon for multiple agencies to get involved in a single case, sharing information that they have gathered with one another to build their case against you.
State law enforcement agencies, like the New York Attorney General’s Office, will also often get involved, particularly if the amount that was allegedly defrauded is relatively low. In these cases, it is not uncommon for federal law enforcement agents to refer the case to their state healthcare industry counterparts for prosecution.
What are the Penalties?
The penalties for being found liable for Medicaid fraud depend on whether the case is being pursued criminally, civilly, or administratively.
Criminal allegations, which require the prosecutor to prove that you intended to defraud Medicaid, carry huge criminal fines, recoupment payments, and potentially even prison time. Medicaid fraud cases are typically a felony offense, so the prison sentence can be longer than a year, and sometimes far longer than a year.
Civil allegations do not require proof that you intended to defraud the program – even accidental overbilling of Medicaid can lead to civil liability. While prison time is not on the table for these cases, the financial penalties can be massive, including:
- Recoupment payments
- Fines
- Other financial penalties
- Exclusion from Medicaid
- Non-payment of future Medicaid claims
The penalties for administrative claims are generally confined to program exclusion or increased scrutiny of future claims against Medicaid. These sanctions can still cripple your professional life or your healthcare company’s financial well-being. In many cases, it can make it no longer worth your time to handle Medicaid patients, which can be a huge setback to your base of clients.
All of these three types of Medicaid fraud enforcement also carry professional consequences. In addition to being excluded from the Medicaid program, you may also face action against your license to practice medicine or your other professional certifications.
Furthermore, Medicaid fraud allegations rarely come unaccompanied by other charges. A common one is that, in addition to committing health care fraud, you also violated the federal False Claims Act. Liability under this law carries treble damages, or paying three times what was allegedly defrauded from Medicaid.
5 Frequently Asked Questions About Oberheiden P.C.’s Medicaid Fraud Defense Practice
1. Where are Your Law Offices on Long Island?
Oberheiden P.C. has two law offices on Long Island. One is just outside of New York, in Great Neck. The other is in central Long Island at Hauppauge. The addresses are:
1. 405 RXR Plaza Suite 405, Uniondale, NY
2. 160 Commerce Drive, Hauppauge, NY
These offices are by appointment only, so make sure you schedule one before visiting.
2. What Does It Mean to Be a National Law Firm?
Oberheiden P.C. is a national law firm, which means that it has law offices in numerous states across the country. In fact, we currently have offices in 44 states and the District of Columbia, with our headquarters in Houston, Texas.
3. How Do You Defend Against an Allegation of Medicaid Fraud?
The best defense strategy will depend on the specific allegations that have been filed, the factual circumstances, and your own needs and interests. Unlike many other criminal defense lawyers who handle Medicaid fraud cases, our attorneys do not rely on a “lack of intent” line of defense. This defense strategy may seem like a good idea because it forces law enforcement to go through the often difficult process of proving what you were thinking at the time of the alleged offense. However, it tacitly admits to the underlying factual allegations by not challenging them, and this exposes you to civil liability for Medicaid fraud if law enforcement cannot prove that you intended to defraud the insurance program. Basically, by using your lack of intent to defend against the criminal charge, you open yourself to a civil claim that you cannot defend against. We try to avoid this outcome by utilizing other defense strategies whenever possible.
4. Why Should I Hire Oberheiden P.C.?
There are numerous reasons to hire Oberheiden P.C. to represent you or your company in a Medicaid fraud case. However, the one that our prior clients keep coming back to is how our attorneys will handle your case and represent you.
Other law firms, including most other criminal defense firms on Long Island, will have a few very experienced defense lawyers as their partners and senior associates, and then numerous junior associates and paralegals. When soliciting clients, the firm will tout the experience of these senior associates and partners. However, when you hire the firm to defend you, you will find that the work on your case will get delegated to the firm’s junior associates and even to its paralegals.
This cannot happen at Oberheiden P.C. because we only employ senior-level associates at our law firm. All of the work that gets done on your case will be performed by our New York Medicaid fraud lawyer whose experience drew you to our firm. We think that this makes our legal representation better than what you would get elsewhere.
5. Why Doesn’t Oberheiden P.C. Call Itself the Best Medicaid Fraud Defense Law Firm on Long Island?
We do not say this sort of thing because we think it means much more when it comes from some of our prior clients. You can read their testimonials here.
Reach Out to the Long Island Medicaid Fraud Attorneys at Oberheiden P.C.’s Long Island Law Office Today
These penalties can disrupt your practice and even alter the course of your life. Protecting yourself from a criminal conviction or a finding of guilt or liability is crucial. Call the New York Medicaid fraud lawyer at Oberheiden P.C. at their national intake hotline, (888) 680-1745, or contact them online for a free consultation and get started on your case today.