NYC Health Care Fraud Lawyer

NYC Health Care Fraud Attorney

Receiving a healthcare fraud accusation in New York can be incredibly stressful. Healthcare fraud convictions can come with penalties that change people’s lives forever. Accusations alone can ruin reputations and professional standing.

Here at the Law Office of Jonathan Savella, we take your charges seriously if you face a healthcare fraud charge. Our NYC healthcare fraud lawyer wants to help you through your challenging time.

Examining Healthcare Fraud

Healthcare fraud includes a wide range of actions within the medical system. These offenses can involve defrauding systems that allow people to get the healthcare they need, so the applicable enforcement agencies pursue these accusations heavily. If you face healthcare fraud charges, it is essential to understand the severity of your situation, what charge you received, and why.

Billing for Services Not Rendered

Billing for services not rendered is an accusation of an individual submitting for services they never performed. The alleged actions can vary, such as someone creating fake patients in the billing system, inflating the number of services they provided a legitimate patient, or billing for unnecessary procedures.

For example, a doctor billing for a complex surgical procedure when they simply performed a diagnostic test could receive billing for services not rendered charge.

Honest mistakes happen all the time. To defend you, we can examine your medical records to determine whether the miskept record was just a mistake or a misunderstanding.

Upcoding

Upcoding means billing for higher-priced services than what was actually delivered. For example, a nurse might code a simple office visit as a more complex consultation to seek a higher reimbursement from the insurance company. Upcoding can also involve fraudulently adding additional diagnoses to a patient’s record to justify more expensive treatments or procedures.

In some cases, upcoding can be a straightforward accident. The codes could seem similar, causing an uncaught issue. Situations due to inadequate training or unclear guidelines should not end someone’s career. We can help demonstrate the lack of necessary knowledge or intent to commit fraud.

Kickbacks

This action can involve healthcare providers receiving illegal payments from certain medical facilities or companies after referring patients to them. Kickbacks can incentivize unnecessary tests, procedures, or prescriptions. Illegal actions like this can inflate healthcare costs.

It is illegal for a doctor to receive a kickback from a nursing home for every patient they refer, regardless of whether the patient actually needs care. Authorities would attempt to prosecute this situation heavily. Kickbacks can also involve pharmacies paying doctors to shill out their medications, even when more effective or affordable alternatives exist.

Receiving a kickback charge does not mean you are guilty. There might be no actual kickback if your referred services were legitimate and had a fair market value. We can fight to show your referrals were based on quality care, not illegal payments.

Duplicate or Phantom Billing

Some people submit duplicate bills to multiple insurance companies to receive payment for the same service. This duplicate billing can also involve billing the patient and their insurance company for identical services.

Phantom billing is billing for services provided by fictitious people or delivered to deceased patients. These schemes can occur due to fake medical professionals in the billing system or by billing for services to patients who passed away recently.

We can often defend against these accusations if the prosecution lacks the necessary documentation to prove their accusation. We can exploit these gaps in evidence to cast doubt on the charges. Additionally, having a documented alibi can be helpful.

Prescription Fraud

Prescribing medications and forging or selling illegal prescriptions can both be actions considered prescription fraud. An example can include a doctor who sells controlled substance prescriptions on the black market or prescribes addictive painkillers to patients who have no legitimate medical need for them.

If the prescribed medications were necessary for your patient’s condition, our attorney can present medical records to support your claim. Also, errors due to incorrect dosages or unclear instructions are not necessarily fraud. Proving unintentional mistakes can help the case.

Home Healthcare Fraud

When people bill for home care services that do not happen or are unnecessary, this can look like home healthcare fraud. People convicted of these actions likely exploited vulnerable populations who rely on in-home care, such as the elderly or people with disabilities. An example is a healthcare provider billing for hours of care that was not necessary or never occurred.

Defending against these accusations can require meticulous records of the services provided, including patient care plans, time logs, and other evidence. Additionally, if the defendant can present informed consent from the patient, this can help the case.

Medical Identity Theft

Accusations of medical identity theft can involve using another person’s identity to get medical services or prescription drugs. These actions can lead to victims receiving financially debilitating medical bills while damaging their credit scores. Sometimes, the victims may not know someone stole their identity until they receive a bill.

With regards to medical identity theft, it is essential to have documented procedures to verify patient identification before providing services.

It is essential to know that these alleged actions are just examples, and the charge you receive can depend on the specific circumstances in your case. A skilled healthcare fraud defense attorney can assure you that you have the strategy to fight your accusations.

The Impact of a Healthcare Fraud Conviction

A healthcare fraud conviction is more than just a legal matter. These situations can have an effect that shatters the entire life you build. Understanding the potential consequences you face when looking at a healthcare fraud accusation is essential.

Imprisonment

Depending on the severity of your charges and the value of the criminal activity, you can face significant jail or prison time. Federal fraud offenses carry harsher penalties compared to state charges. Facing time behind bars means you will separate from family, loved ones, and your community. This time away can disrupt or eradicate your employment, education, and overall life trajectory.

Steep Financial Penalties

Healthcare fraud convictions come with significant financial penalties, making it a serious financial crime. The potential fines can be debilitating. Many people do not have the resources to accommodate such financial consequences. You can struggle for years or the rest of your life trying to rebuild without paying for basic necessities.

Revocation of Professional License

Many people working in the healthcare field rely on their professional licenses to provide care properly. A healthcare fraud conviction can have your license revoked, leaving you with a shell of what your opportunities once were. This devastating impact on your career can make it impossible to find new employment in the field you worked hard to get into.

Being forced to retrain for a new profession can be time-consuming and expensive. Many people in this situation can find it difficult to ever recover from the life they had before their conviction.

Exclusion from Federal Programs

Defrauding healthcare programs will likely cause people to lose access to similar federal programs. An inability to participate in programs like Medicare and Medicaid can lead to limited access for patients and an inability to work without paying out of pocket for medical expenses.

Reputational Damage

While sometimes people overlook the importance of their reputation, the healthcare field requires a good reputation. Healthcare fraud can severely damage the reputation of even the most respected professionals. The stigma associated with a criminal record can be only part of the issue when the crime is related to a person’s daily work.

Additionally, criminal records can prevent you from finding employment, securing loans, renting an apartment, and doing other activities that may have been easy to take for granted before the conviction.

The consequences of healthcare fraud can be all-encompassing. If you face these charges, you need to take them seriously. Obtaining an attorney’s assistance can make a difference in your case. Our NYC healthcare fraud attorney can be available to help discuss and work through your case whenever you need.

We can help you navigate the complex healthcare fraud legal system, and we understand the mountain of potential damage you face. Our law firm is dedicated to doing what it takes to attain an ideal outcome for you.

The Importance of Early Intervention

Like with many serious charges, early intervention is essential. The sooner you contact an experienced attorney, the sooner they can help you build a strong defense strategy. Early intervention can help you avoid turning a bad situation into a worse situation. Here are essential things you should remember early in your legal process:

• Contact a healthcare fraud attorney. While this may seem straightforward, many people do not realize they can contact an attorney before receiving a charge. If you know you are under investigation, you can contact an attorney. Receiving an attorney’s help as early as possible can significantly change the trajectory of your case.
• Do not speak with law enforcement without an attorney present. After contacting an attorney, you should never speak with law enforcement without your representation unless you consult with the attorney first. Remain polite when around law enforcement, but know anything you say can and will be used against you. Your attorney can advise you on how to proceed in any situation with officers present.
• Gather any relevant documentation. Begin collecting documentation to prove your innocence as soon as you can. Medical records, billing statements, insurance company correspondence, notifications from government agencies, and any other documentation can help your attorney craft a strong defense against your accusations.

NYC Health Care Fraud FAQs:

How Do You Report Medical Fraud in NY?

If you want to report medical fraud in NY, you can attempt a report in several ways. Contacting the Office of the Medicaid Inspector General can put you in touch with the agency responsible for investigating and prosecuting Medicaid fraud in New York. With them, you should be able to report suspected fraud online or through their hotline.

Another way to report medical fraud is to contact the New York State Department of Health, which investigates healthcare fraud.

Is Medicaid Fraud a Felony in New York?

Whether medical fraud is a felony in New York depends on the severity of the offense. Medicaid fraud can become a felony with the right factors present. New York can classify healthcare fraud based on the value of the aspects in the case. Petit, grand, and felony theft are each different levels of Medicaid fraud and differ depending on the value of services. Petit larceny is usually a misdemeanor, while grand and felony larceny are large-scale felonies.

What Is the Medicaid Fraud Control Unit in NY?

he Medicaid Fraud Control Unit in New York is a unit under the Office of the Medicaid Inspector General. Its members focus on investigating and prosecuting people suspected of Medicaid fraud in New York. They also work with law enforcement agencies and healthcare providers to locate seemingly fraudulent activities within the Medicaid system.

If the Medicaid Fraud Control Unit suspects you of a crime in New York, it can be wise to seek legal representation before the investigation progresses.

How Do I File a Complaint Against a Medical Provider in New York?

Filing a complaint against a medical provider in New York can consist of contacting the New York State Department of Health (DOH). The complaint you file can include your concern about the medical provider’s practice, among other information. The DOH investigates concerns like yours and looks into licensed healthcare professionals to uncover fraudulent activity.

If this organization finds suitable evidence to substantiate your claim, it may take action to ensure patient safety.

Contact Us Today for Help With Your Healthcare Fraud Case

Facing prison time, massive fines, and a permanent mark on your record can shake people with the most robust mental fortitude. A healthcare fraud conviction can be life-altering and prevent you from ever returning to the life you had before.

Retaining the services of a skilled NYC healthcare fraud attorney is invaluable when your life is on the line. The Law Office of Jonathan Savella is here for you. Contact us today for help with your case.