New York Medicaid Fraud Control Unit

New York Medicaid Fraud Control Unit (MFCU) is a law enforcement agency within the Office of the New York Attorney General. It exists for only one purpose: to investigate and prosecute Medicaid fraud by service providers in any form in New York State. The MFCU has state-wide jurisdiction and several regional offices. In the New York City area, their offices are located in Manhattan and in Long Island.

What is different about the MFCU compared with other law enforcement agencies is that it is partially self-funded? 25% of the MFCU budget is from recoveries in its Medicaid fraud cases. It is no surprise that the MFCU is extremely aggressive in its investigations and prosecutions. Not all the MFCU investigations are criminal, although they all have potential criminal consequences. The NY Attorney General, under whom the MFCU operates, is authorized not only to prosecute crimes but also to bring civil recovery actions and asset forfeiture actions.

Most investigations by the New York Medicaid Fraud Control Unit begin with a referral from one of the many New York administrative agencies, usually the NYS Office of the Medicaid Inspector General or the Department of Health if the case involves nursing homes. Several detectives and a prosecutor will be assigned to each case.

In most cases, an MFCU investigation resembles regular police work when agents will go out and speak with people trying to gather information. At times the Attorney General will issue subpoenas for the production of documents. Sometimes, the MFCU agents will raid a medical office with a search warrant and seize computers and documents.

The MFCU only prosecutes Medicaid fraud committed by healthcare service providers. Most cases involve billing for services not provided or unnecessary services. Other billing issues that may result in a criminal investigation are upcoding, double billing, and, of course, illegal kickbacks.

In our practice, we defended numerous clients investigated by the MFCU for all of these activities. Our clients were physicians, nurses, dentists, social workers, psychologists, physical therapists, home care aides, and ambulette companies.

As with any criminal investigation, it’s important to stay calm and avoid speaking with investigators until you’ve had the opportunity to talk with an attorney. Remember that any piece of information you give the investigators will be used against you later. If you do want to cooperate, there is a proper way to do it, and giving away information when the government asks is simply not it.

The Medicaid Fraud Control Unit investigation is a serious business that can result in a criminal conviction, license suspension or revocation, and exclusion from the Medicaid program. It can also cost you hundreds of thousands of dollars in civil damages. You need to speak to a New York attorney experienced in dealing with the MFCU and Medicaid fraud issues.

Stealing a prescription pad and filling out a fake prescription or altering a legitimate prescription is another type of fraud commonly investigated by MFCU. It can result in a charge of forgery or criminal possession of a forged instrument. If you use Medicaid to pay for the forged prescription, you can also be charged with Medicaid fraud.

Criminal possession is usually easier to prove, since frequently the prosecution will not have direct proof, such as eyewitness testimony, that you actually committed the forgery. Both possession and forgery are felonies, punishable by up to seven years in prison. Medicaid fraud is a separate charge, which can result in additional prison time, as well as assessments for restitution and/or fines.

To establish the crimes of forgery and/or criminal possession of a forged instrument, the prosecution must prove beyond a reasonable doubt that you had the intent to deceive, injure, or defraud another. Further, in relation to a physician or doctor’s prescription in New York, there is specific language goerning both Forgery and Criminal Possession of a Forged Instrument. New York Penal Law sections 170.10(5) and indirectly 170.20 states that these crimes have been committed if the written instrument purports to be:

“A prescription of a duly licensed physician or other person authorized to issue the same for any drug or any instrument or device used in the taking or administering of drugs for which a prescription is required by law.”

However, if the prosecution does establish that you forged or knowingly used a forged prescription and the prescription was paid for by Medicaid, it is likely that this will be enough to support a conviction of Medicaid fraud.

Even if you have already obtained the prescription medicine and you no longer have the fraudulent prescription because you gave it to the pharmacist, you can still be prosecuted. If the prosecution can prove that you possessed that prescription earlier and gave it to the pharmacist, you can still be charged with one of these crimes.

It is clear that in New York, offenses related to prescription abuse are a serious matter. Further, these offenses often come “bundled” with other offenses, such as Medicaid fraud, private insurance fraud, and narcotics offenses, all of which can have severe legal consequences. Convictions of fraud or forgery, as well as many narcotics offenses, are considered crimes of moral turpitude for the purposes of immigration and professional licensing. A conviction of Medicaid fraud will also result in exclusion from Medicaid or Medicare; the practical consequences of such exclusion are being barred from any employment for a health care provider that participates in Medicaid.

If you have been arrested and charged with any offenses related to altering or stealing a prescription, you should contact an experienced defense attorney right away. The sooner you act to protect yourself, the more your attorney will be able to do to help you.

Medicaid fraud lawyers with Norman Spencer Law Group handle cases with the Medicaid Fraud Control Unit on a daily basis. Over the years, we have assisted numerous individuals and businesses accused of wrongdoing by overzealous MFCU prosecutors. Amongst our clients are nursing homes, medical and dental clinics, physical therapists, mental health professionals, nurses, billing companies, and transportation companies. We believe that reaching the optimal results in MFCU cases is better achieved by mounting an aggressive defense campaign and holding the government to its obligations.

If you have been targeted by the New York Medicaid Fraud Control Unit, call our New York Medicaid fraud lawyers today at (212) 577-6677 today to set up an immediate consultation.