The Difference Between Medicaid Fraud and Medicaid Abuse:

Wrongful use of the Medicaid program can happen on both sides of the hospital counter. Medicaid fraud is when individuals wrongfully apply for Medicaid benefits. Medicaid abuse occurs when doctors or supplies don’t follow government regulations on the program in order to bill higher for services.

Medicaid abuse has been in the news very frequently in recent months. The United States Attorney General’s Office has been cracking down on abuses perpetrated by doctors and supplies. Medicaid abuse costs taxpayers billions of dollars. Sometimes doctors and supplies are unaware they are committing Medicaid abuse. Often times the doctors have a separate entity in charge of their billing practices. Doctors and providers are unaware that someone may be committing Medicaid abuse in their name. It is important for doctors, suppliers, and other health professionals to be in compliance with Medicaid/Medicare regulations. Speaking with an attorney’s office that specializes in the field of Medicaid/Medicare Fraud and Abuse can provide a Compliance Program. An experienced attorney will be able to go through your records to make sure your practice/business is in compliance with Medicaid/Medicare regulations.

Medicaid/Medicare Benefits and the Human Resource Administration (HRA):

The New York City Human Resource Administration provides temporary social services, economic needs, and health care to more than 3 million New Yorkers.

Through the HRA, individuals are able to apply for Medicaid, Medicare, and SNAP Benefits. It is important to be truthful and forthcoming in your application to these programs. The HRA has an investigative division dedicated to detecting Medicaid/ Medicare fraud, as well as SNAP fraud.

In applying for these Medicaid, Medicare, and SNAP programs you enter yourself into a tacit agreement with a government agency. As such, the HRA have access to your financial records, and are also able to conduct investigations of your home, job, and acquaintances. The HRA investigators can see your bank balances, your work income, and interview your neighbors, employer, coworkers, etc.

Honest and full disclosure in applying for Medicaid, Medicare, and SNAP benefits is the best policy. If you realize you have made a mistake in your application, or if you are under HRA investigation, it is vital to contact an experienced attorney right away. An experienced attorney in the field of Medicaid/ Medicare fraud and SNAP fraud will be able to serve as an intermediary between you and HRA, in order to rectify any issues.

What is the difference between Medicaid and Medicare? Is it really free?

Medicaid provides health coverage for millions of low income Americans for free or at a very low cost. In certain States, there is even emergency Medicaid to serve visitors who find themselves in a medical emergency situation. Medicare provides lower medical care for older citizens of the United States. The program was created to help aging citizens deal with the high medical costs they face as they age. The key difference in Medicaid and Medicare is that Medicaid is a benefits program, whereas Medicare is an entitlement program.

Medicare covers almost everyone over 65 years old. Medicare is a federal program, and the regulations that guide it are the same all over the country. Medicare is offered through the Social Security office. As such, it is an entitlement program.

Medicaid covers low income and financial dire people and families. Medicaid is available nationwide, however it is governed by each State individually. Medicaid availability and regulations will vary from State to State. To obtain Medicaid, the individual must prove that they are considered a low-income financially needed person or family. As such, it is a benefits program.

Medicaid appears free, but if the Human Resources Administration investigates you, it is possible that you will have to pay back the cost of your coverage. It is important to note that cost of coverage does not only occur when you visit the doctor’s office. The cost of coverage includes your monthly medical premiums. You will be required to pay back the coverage regardless of whether not you visited a doctor.

If you are investigated for Medicaid Fraud in New York, you need to speak with our experience NYC Medicaid Fraud Lawyers. We have represented hundreds of clients investigated for and accused of Medicaid fraud   by local, state, and federal authorities and we have a reputation of being the “go-to” law firm for Medicaid Fraud in New York City.