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Medicaid Fraud Investigations and Subpoenas

The Attorney General’s Medicaid Fraud Control Unit investigates and prosecutes Medicaid fraud in the criminal courts.  The investigation is often started by a referral from the Office of the Medicaid Inspector General (OMIG), but it may also be triggered by complaints from patients, a whistleblower, or a Medicaid managed care plan.

You will first learn about a Medicaid fraud investigation when investigators from the Medicaid Fraud Control Unit show up asking questions or serve you with a subpoena duces tecum.  However, this is not the start of their investigation.

By the time you hear from investigators or receive a subpoena, they have already analyzed your billing records.  They may have spoken with patients, a whistleblower, and former employees. They want to speak with you and obtain your records because they already believe that you may be guilty of Medicaid fraud.

You should consult with an experienced Medicaid fraud defense lawyer before you speak with investigators or respond to a subpoena. Our lawyers take a step-by-step approach to responding to subpoenas.  First, we examine the subpoena to determine whether it can be challenged or limited.  Then, we contact the prosecutor or investigator in charge, identify their areas of concern, determine the appropriate scope of your response, and ensure that your response goes no further than what is legally required.

We also help you understand whether you have a problem and, if so, how to prepare your defenses. Some of the most common types of Medicaid fraud include:

  • Billing for services or equipment not provided;
  • “Upcoding” or billing for more expensive services or equipment than actually provided;
  • Overutilization of medical procedures or services;
  • “Unbundling” services or equipment that should be billed together at a lower reimbursement rate;
  • Offering or accepting “kickbacks” in return for patient referrals;
  • Billing for services or equipment that Medicaid determines are not medically necessary.

As with diseases, early detection and prevention can often avoid or limit the harm from a Medicaid investigation.  Our experienced Medicaid defense lawyers will review your records, identify concerns or problem areas, and negotiate with investigators and prosecutors.

If it makes sense for you to speak with the prosecutor, we will negotiate the ground rules.  This may include a “proffer” agreement that allows you to tell your side of the story with a written promise from the prosecutor that nothing you say can be used against you in court.  Depending on the facts, we are often able to prevent criminal charges from being filed and avoid professional disciplinary complaints that could lead to licensing action.

If you have received a Medicaid fraud subpoena or a visit from investigators, you need to speak with an experienced Medicaid fraud defense attorney immediately.  To schedule a consultation, call John Howley, Esq. at (212) 601-2728.