Medicaid Fraud Cases Can Result in Civil and Criminal Penalties
Medicaid fraud investigators have several options if they discover that you have provided inaccurate or incomplete information on your applications for Medicaid or Family Health Plus benefits.
The investigator may offer you a confidential settlement. The investigator may send your case for civil litigation – in other words, you may be sued for the amount of benefits you received. Or the investigator may refer your case to the local District Attorney for criminal prosecution.
Some of the most common types of criminal charges for Medicaid fraud are:
Making a False Written Statement: Knowingly making a false statement on your Medicaid or Family Health Plus application is a class A misdemeanor. You can be sentenced to spend up to one year in jail. (N.Y. Penal Law § 210.45).
Offering a False Instrument: Submitting an application or recertification that you know contains false information may be charged as a felony if the government can prove that you submitted the document with the intent to obtain benefits for which you did not qualify. This is a class E felony. You can be sentenced to spend up to four years in prison. (N.Y. Penal Law § 175.35).
Welfare Fraud: Lying on an application or recertification to obtain any form of public assistance benefits worth more than $3,000 is a class D felony. You can be sentenced to spend up to seven years in prison. (N.Y. Penal Law § 158.15).
Grand Larceny: Prosecutors often add a charge of grand larceny based on the value of the benefits you received. In Medicaid fraud cases, the charges are usually a class D felony if the benefits exceeded $3,000. That could result in you spending up to seven years in prison. If the benefits exceeded $50,000, then you could be charged with a class C felony. That could result in you spending up to 15 years in prison. (N.Y. Penal Law § 155.35(1)).
In addition to serving time in prison, you may be ordered to pay back all the benefits that you received. This could amount to tens of thousands of dollars. You also may be fined up to $1,000 per count for misdemeanors and up to $5,000 per count for felonies.
Why do some Medicaid fraud cases result in settlements, while other cases result in serious criminal charges? It all depends on how you respond to the investigation.
Anything you say to the investigator can and will be used against you. On the other hand, if you refuse to cooperate with the investigator, that may cause the investigator to send your case to criminal prosecution instead of a civil settlement. You need to develop a strategy based on your specific facts and circumstances.
Get an Expert on Your Side: If you receive a letter from the Bureau of Fraud Investigation, or if you are contacted directly by a Medicaid fraud investigator, then you should contact an experienced Medicaid fraud lawyer immediately to protect your rights. In many Medicaid fraud cases, contacting a lawyer can mean the difference between a confidential settlement or serious criminal charges.
For more information, click here to download our free report, "5 Deadly Mistakes in Medicaid Fraud Investigations."
Then call our law offices at (212) 601-2728 to schedule a consultation with an experienced Medicaid fraud defense attorney.
Medicaid fraud cases are often won (or lost) at the investigation stage, Before you talk to investigators, educate yourself by downloading a free copy of our special report.