Criminal Defense Lawyers

New York Medicaid Audit Lawyer

Last Updated on: 24th February 2025, 02:48 am

NEW YORK MEDICAID AUDIT LAWYER

Are you worried about a Medicaid audit that was initiated by the government? If so, you’re not alone, and we understand how serious your situation may be. We have represented clients nationwide in all types of medicaid audit cases.

EXPERIENCED
We have over 50 years of combined experience. Our team has successfully defended countless clients who were facing audits, investigations, and criminal charges related to Medicaid. If you are accused of medicaid fraud, we can help you. We have over 50 years of combined experience dealing with medicaid audits.

DEDICATED
We are available 24/7 to hear your story. Our objective is to help you avoid harsh penalties, like losing your license or facing criminal charges. Sometimes, the government can make mistakes when alleging medicaid fraud, and will do medicaid audits without the correct information.

What Is A Medicaid Audit, And Why Should You Care?
An audit that was initiated by the Office of the Medicaid Inspector General ( OMIG ) is usually a thorough review of claims, billing, and documentation for healthcare providers who are enrolled in the Medicaid program. When you receive the notice of an audit, it can lead to financial penalties or even criminal consequences, especially if the auditors find that you submitted incorrect information or fraudulent bills. Mistakes are not necessarily thought of as fraud; if you can prove there was no intentional fraud.

Why is this such a big deal? The government, meaning federal agencies or New York State agencies, can impose large fines and possible exclusion from future Medicaid participation. That means you can lose your right to bill Medicaid entirely, which can destroy your practice. Jail time is also possible.

Penalties That You Could Face
Providers who are caught committing Medicaid fraud can face penalties such as:

• Criminal Charges: Felony convictions, leading to jail or prison time.
• Large Fines: Monetary penalties which can cost hundreds of thousands of dollars, causing huge strains on your business and your family.
• Program Exclusion: A permanent ban from billing Medicaid or other government programs, which means a total loss of a major revenue source.
• Professional Sanctions: Licensing boards that review criminal cases can revoke your ability to practice, resulting in a stalled or ruined career. This means you’ll never practice medicine again.

These outcomes can be devastating to providers who are relying on Medicaid payments as part of their daily operations. If convictions occur, you might spend time away from your family, and you might lose your freedom or your professional license. There is no way back, once you lose the medicaid audit.

Crimes And Punishments Under Medicaid Law
False Claims: Submitting false claims that were meant to get unearned reimbursements can lead to fraud charges. When you face fraud charges, you risk felony convictions. It is “ok” if you make an intentional mistake, but it’s not ok if you make a pattern of engaging in this behavior.

Kickbacks And Bribes: Accepting or paying illegal referral fees that were intended to get more Medicaid business can also trigger federal violations under the Anti-Kickback Statute. If you’re found guilty, it can result in both civil and criminal penalties, including substantial prison sentences.

Overbilling: Charging for services which were not performed may seem like a minor mistake, but the government can treat it as intentional crime. That can lead to steep fines, jail time, and serious harm to your reputation.

When convictions occur, the consequences can go far beyond a courtroom. They can impact your family, your bank account, and your entire future.

Evidence That Was Illegally Obtained Can Be Thrown Out
Auditors sometimes gather documents or statements in ways that do not follow standard procedures. Evidence that was illegally obtained will be thrown out, which means the government cannot rely on that evidence in court, often weakening the case against you. As a result, you can walk away with reduced charges or potentially no charges at all. The goal is to get the case dismissed, and allegations thrown out – rather than going to court.

STRATEGIES WE USE TO DEFEND YOU
We know how to fight and win. Our medicaid fraud team, which is staffed by attorneys who have decades of experience, uses multiple strategies to help you.

1. Early Intervention

   • We contact investigators who are auditing your records as soon as possible.
   • We set the understanding that we are serious about defending you, which can lead to quicker settlements or dropped charges.

2. Thorough Documentation Review

   • We examine claims that were flagged by the auditors to see if they truly violate Medicaid rules. Mistakes are not fraud, or crimes, and cannot be treated as such. The goal is to show that this is a one-off mistake.
   • We identify common billing errors, so we can correct them and argue that you did not act intentionally.

3. Challenging Questionable Evidence

   • We investigate whether the auditors who were conducting the review followed the law.
   • Evidence that was not gathered legally may be ruled inadmissible, which can lower the odds of harsh penalties or prison time. Evidence being thrown out can get the case dismissed.

4. Negotiation And Litigation

   • We negotiate with prosecutors who are building a case against you, often aiming for reduced charges, or getting all charges dropped completely.
   • If necessary, we take your case to trial and present all possible defenses, such as good faith, lack of criminal intent, or reliance on professional advice.

When we reduce or dismiss the charges, we protect your license, your reputation, and your family’s future.

RISK FREE CONSULTATION
Are you facing a Medicaid audit that seems to threaten your practice, your income, and your freedom? If so, we can help you. Our legal team, which has extensive experience dealing with Medicaid matters, is ready to talk to you right now. We are available 24/7 for a risk free consultation.

CLIENT TESTIMONIAL
“We reached out to Spodek Law Group, and everything changed. When auditors accused us of overbilling, we were terrified. Todd Spodek and his team stepped in, reviewed our billing data, and found a series of minor administrative mistakes—not intentional fraud. The government’s case collapsed. We owe everything to them.”

WHY CHOOSE SPODEK LAW GROUP?
We are recognized for top-rated, white-glove service and fierce representation. If you want a law firm that cares about your rights, look no further.

NEW YORK MEDICAID LAWYERS YOU CAN TRUST
If you’re worried about being accused of wrongdoing, let us defend you. If you’re accused of submitting false documents, we can craft a defense strategy. If you’re afraid of losing your license, we will fight tirelessly to keep you in business.