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Relevant Laws

If you are investigated and/or prosecuted for medicaid fraud there are a few potential laws and legal entities you need be aware of:

New York State Office of Medicaid Inspector General

This NYS Office of Medicaid Inspector General was established in 2005 within the Department of Health.  This office coordinates fraud prevention, detection and investigation activities of all state entities responsible for adminstrating the medicaid system.

The NYS Office of the Medicaid Inspector General has the authority to investigate medicaid fraud by providers and recipients. The OMIG can pursue civil and adminstrative enforcement actions against individuals commiting fraud or abuse. However, the OMIG does not have authority to prosecute criminal violations.

New York State Attorney General’s Medicaid Fraud Control Unit

The MFCU was established to comply with federal laws regarding medicaid fraud. The federal government reimburses 75% of their expenditures in combating medicaid fraud. The focus of MFCU is on provider fraud. They are authorized to pursue criminal and civil litigation for medicaid fraud. The MFCU investigates and prosecutes patient abuse and neglect in medicaid participating health carea facilities and nursing homes. The MFCU aggresively pursues medicaid overpayments.

MFCU’s authority is limited as they are precluded by federal law from examining medicaid claims data to establish new prosecutions. Further, their recipient invetigations are only when the recipient conspired with a provider in a medicaid fraud conspiracy.

New York State Office of Welfare Inspector General 

This office is a division of MFCU which is focused on recipient fraud. This office has authority to investiagate and prosecute recipient and provider for medicaid fraud.

New York City District Attorney’s Office

The district attorney’s office of the five boroughs has jurisdiction to proescute criminal welfare fraud. They prosecute both provider and recipient but more frequently they have been focused on recipient fraud.

NYC Human Resources Adminstraiton, Department of Social Services

The NYC HRA investigates and commences adminstrative proceedings against recipients of medicaid for fraud. HRA refers cases for civil litigation and/or criminal prosecution depending on the facts and circumstances of the case. The HRA also investigates provider fraud.

 NY State Comptroller

The NY State Comptroller may audit DOH with respect to fraud. However, they do not have authority to investigate and prosecute medicaid fraud.

If you are the current target of a medicaid fraud investigation, and/or have reason to believe you are the target of a medicaid fraud investigation call our office 24/7 for immediate assistance. We can be reached at (212) 300-5196.

Questions? Contact us today.

If you are the target of a medicaid fraud investigation, call our office 24/7 for a free consultation. We have offices in Brooklyn, Manhattan and Queens.

(212) 300-5196 or info@spodeklawgroup.com