Norman Spencer: Top-Rated Medicaid Fraud Lawyer In NYC

When you are a target of a Medicaid fraud investigation, you may be at a loss as to what to do and where to seek help. The worst thing you can do is try to fix the situation yourself.

If you are facing allegations of Medicaid fraud, it is essential to have an experienced and qualified lawyer on your side to protect your rights and defend you against the charges. As a Medicaid fraud lawyer, I have the knowledge, experience, and skills to provide the legal representation you need to navigate the complex legal system and achieve the best possible outcome in your case.

What is Medicaid Fraud?

Medicaid is a federal and state-funded healthcare program that provides medical assistance to low-income individuals, families, and individuals with disabilities. It is designed to help cover the cost of medical care for those who may not be able to afford private health insurance.

Medicaid fraud is the intentional act of submitting false or fraudulent claims to the Medicaid program for payment.

What are Examples of Medicaid Fraud?

Medicaid fraud can take many forms, including billing for services or supplies that were not provided, providing unnecessary or inferior services or supplies, billing for a higher level of service than was provided, and misrepresenting the diagnosis or treatment of a patient to receive higher reimbursement. Individuals, such as healthcare providers or beneficiaries, and organizations, such as hospitals, clinics, or nursing homes, can commit Medicaid fraud.

In New York City, Medicaid fraud can be considered a felony offense. The specific penalties for Medicaid fraud depend on the amount of money involved in the fraudulent activity and the severity of the fraud. In cases involving large amounts of money, the penalties may be even more severe.

Medicaid fraud consequences for healthcare providers can range from huge fines or loss of licensure to the prohibition of accepting Medicaid payments or prison time. Recipients accused of Medicaid fraud can face criminal prosecution and repayment of hefty sums of money to the government.

Below you’ll find a detailed description of the health care fraud laws in New York:

Health Care Fraud in the 1st Degree

• Health Care Fraud in the First Degree (Penal Law § 177.25) is defined as when the individual intends to defraud a health plan and then knowingly and willfully gives false or incomplete information to receive reimbursement or payment from a health care plan to which they are not entitled
• First-degree charges require the total amount stolen to exceed $1 million and occur in a one-year period
• Considered a B non-violent felony
• Penalties
  • a minimum of 1 to 3 years of incarceration and a maximum sentence of 8 1/3 to 25 years

Health Care Fraud in the 2nd Degree

• Health Care Fraud in the Second Degree (Penal Law § 177.20) involves the same mental state as first-degree charges, but the total amount stolen must be up to $50,000 in a one-year period
• Considered a C non-violent felony
• Penalties:
  • Potentially includes probation for first-time offenders, but punishable by up to a maximum of 5 to 15 years in state prison

Health Care Fraud in the 3rd Degree

• Health Care Fraud in the Third Degree (Penal Law § 177.15) requires the total health care funds stolen to exceed $10,000 in a one-year period
• Considered a D non-violent felony
• Penalties
  • potentially includes probation for first-time offenders, and the maximum sentence is up to 2 1/3 to 7 years of incarceration

Health Care Fraud in the 4th Degree

• Health Care Fraud in the Fourth Degree (Penal Law § 177.10) is considered an E non-violent felony
• Fourth-degree charges require total health care funds stolen to exceed $3,000 in a one-year period
• Penalties
  • most likely includes probation for first-time offenders, and the maximum sentence is 1 1/3 to 4 years in prison

Health Care Fraud in the 5th Degree

• Health Care Fraud in the Fifth Degree (Penal Law § 177.05) is considered a Class A misdemeanor.
• Fifth-degree charges do not require a total stolen dollar amount or a time period constraint.
• Penalties
  • Most misdemeanor crimes do not exceed one year in jail, and first-time offenders are often not sentenced to incarceration.

In addition to criminal penalties, individuals and organizations convicted of Medicaid fraud may also face civil penalties, including the repayment of any fraudulent payments received from Medicaid and the imposition of fines. Medicaid fraud can also have serious collateral consequences, such as the loss of professional licenses, the inability to participate in government programs, and damage to one’s reputation and career.

The above reasons are why if you are facing allegations of Medicaid fraud in New York City, it is vital to seek the help of a qualified attorney like Norman Spencer to help you.

Norman Spencer Law Group PC is a leading NYC-based Medicaid fraud lawyer representing New York City residents in fraud investigations via Medicaid, Family Health Plus program, public assistance, or Food Stamps.

With one of the busiest firms in the state and hundreds of successfully resolved Medicaid fraud cases behind our backs, we have all the experience required to help you.

To qualify for Medicaid or Food Stamps programs, applicants must meet specific criteria, the most important being household income requirements. Intentionally providing false details on the application is a crime. The government tries hard to eliminate fraud to keep Medicaid costs down. However, despite the good intentions and the complexity of healthcare regulations, the officials sometimes target innocent people. In this situation, to prove the person’s innocence or minimize penalties, it is crucial to hire an experienced Medicaid fraud lawyer.