New York Medicare/Medicaid Fraud Lawyer

Medicare and Medicaid are programs that provide health insurance benefits to low income families and the elderly. When the government programs are abused by fraud, access to care is compromised and medical care and treatment costs grow.

A New York Medicare/Medicaid fraud lawyer represents individuals, insurance companies, and medical professionals accused of committing Medicare or Medicaid fraud. To defend against such a charge, an individual should not hesitate before contacting an experienced New York fraud attorney immediately.

Medical Care and Treatment Groups

Medicare is a federal health insurance program for seniors that retire or reach the age of 65. Medicaid is a program that provides medical health insurance to low-income families, including children and the elderly.

When a person receives medical care or treatment under the Medicare or Medicare programs, three main players are part of the transaction: the medical provider, the patient, and the insurer. Each of these players can commit Medicare or Medicaid fraud. To best understand the elements of the charge, an individual should not hesitate before contacting an experienced Medicare fraud attorney in New York.

Fraud and Abuse Laws    

There are several federal laws that apply to medical professionals, including physicians. To fully understand these laws, a person should contact a Medicaid fraud lawyer in New York as soon as possible. These laws include: 

  • The Federal False Claims Act (FCA)
  • The Anti-Kickback Statute (AKS)
  • The Criminal Health Care Fraud Statute
  • The Physician Self-Referral Law (Stark Law)
  • The Exclusive Statute
  • The Civil Monetary Penalties Law
Provider Fraud and Abuse     

Medical providers, including hospitals, physicians, laboratories, medical imaging centers, and other medical care professionals are all considered providers. The federal laws listed above apply to all providers and can lead to the denial of claims, fines, and criminal charges. Common examples of medical professional or provider Medicare or Medicaid fraud include:

  • Billing for services not performed
  • Duplicate billing
  • Falsifying a diagnosis
  • Accepting kickbacks for patient referrals
  • Order unnecessary tests
  • Over medicating or prescribing medications
Individual Fraud and Abuse     

Medicare and Medicaid fraud by an individual involves knowingly misrepresenting the truth to obtain a benefit, or health insurance as is the case with Medicare and Medicaid fraud. Such acts can be effectively defended after contacting a New York Medicaid attorney.

Common examples of individual Medicare or Medicare Fraud include: 

  • Filing a claim for a service not received
  • Forging or altering receipts
  • Selling medical equipment or medications on the black market
  • Providing false information to apply for services
  • Doctor shopping to obtain multiple prescriptions
  • Using someone else’s insurance to receive medical care or treatment
  • Insurer Fraud and Abuse 

Insurers are the third group of people and companies that can run afoul of Medicare and Medicaid programs with fraud and abuse claims. Common examples of insurer Medicare or Medicaid fraud include:    

  • Overstating the cost of services
  • Misrepresenting health plan benefits when members are enrolling in plan
  • Undervaluing the amount owed by the insurer to a health care provider
  • Denying valid claims
Contact an Attorney

Medicare and Medicaid fraud allegations affect an individual’s rights to obtain future health care benefits.

To resolve these charges, a jail term or sentence may be imposed, but in almost all cases restitution or monetary reimbursement to state or federal authorities will have to be made. Since medical care and treatment is expensive, the restitution amounts may quickly land in the thousands of dollars range.

A New York Medicare fraud Lawyer helps people minimize jail time and set payment schedules to resolve any court ordered restitution. Contact a Medicaid attorney in New York City to help you resolve this criminal matter.

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