Medicaid Fraud

Delaware Medicaid Fraud Defense Lawyers

If you live in Delaware and are being investigated, or are facing charges related to, Medicaid fraud or Medicare fraud you need the help of an experienced Delaware criminal defense attorney to protect you. The Delaware Medicaid fraud defense attorneys at The Law Office of John R. Garey have many years experience handling Medicaid fraud defense cases.

Please do not wait to contact Dover Delaware Medicaid Fraud Defense Attorney John R. Garey. Dial 302-244-5312 for a free initial consultation. Mr. Garey represents the accused throughout all of Delaware including Wilmington, Newark, Middletown, Dover, Milford, Seaford, Georgetown, Lewes and the DE resort areas.

Medicaid Fraud Defined

Government programs such as Medicare, Medicaid, and immigration laws are constantly changing. Each day it seems as though it is more difficult to keep up with the ever-changing rules when it comes to government programs. With the advent of Obamacare, Medicaid rules have become even more complex than before. As a result, more cases of Medicaid fraud are being brought against unsuspecting persons than in years past. Being charged with Medicaid fraud cannot only be stressful and time-consuming when trying to prove one’s innocence but if convicted the penalties can be devastating. Hefty fines, revocation of professional credentials and even prison time can await those convicted of this crime. To make sure this does not happen to you, there are many things to be aware of when it comes to Medicaid fraud.

Medicaid Fraud Investigations

Medicaid is a medical coverage program run jointly between state and federal governments. Medicaid provides medical coverage to those who cannot afford it themselves. Because Medicaid benefits recipients can’t pay for the insurance costs, the government picks up the bill, which is very high. Obviously, the government is trying to cut down the costs by eliminating fraud. However, in doing so they often accuse people who have no intention of defrauding the government.

Medicaid eligibility depends primarily on the household income. In Delaware, those applying for Medicaid (or Food stamps) must fill out an application in which they are asked to disclose who the members of their household are, what their household income is, whether anyone has access to health insurance through employment, and other facts. Providing false information on the Medicaid application is fraud. The government relies on the information provided to determine eligibility. If the information is false, the government has paid for the family’s health insurance but the family was not entitled to it. In other words, if you submit false information on your Medicaid application and your application was approved, you have defrauded the government of thousands of dollars.

What Prompts Medicaid Fraud Investigations

Most recipient (as opposed to health care providers) Medicaid fraud investigations in Delaware are conducted by the Department of Social Services Bureau of Fraud Investigations (BFI).

Unlike what most people think, most investigations are not triggered by anonymous reports. The government uses various computer databases to look for unreported income or suspiciously low income.

For example, if someone is working on the books and not disclosing their income on the Medicaid application, the program will simply catch the discrepancy by comparing the HRA records with those of the Department of Labor and the case will be flagged.

Alternatively, if the household is declaring a very low income, so low, in fact, that it is difficult to explain how the family meets its expenses (mortgage payments, car lease, etc) the case will be flagged as well.

Not disclosing your household income is the most common troublemaker. Not disclosing your significant other’s income because you are not married or live separately (or on and off) is part of the problem.

Once an investigation is begun, the situation can quickly escalate far beyond what may be expected. A fraud suspect usually receives a letter from the investigator, stating the nature of the investigation and asking them to produce certain documents to answer the accusations. In most cases, a face-to-face interview is also requested.

Before speaking with the investigator, it’s vital to keep in mind that person already believes you are guilty. It is even more vital to understand the following:

  1. By the time you receive the interview (target) letter, the investigator already knows most of the information requested in the letter
  2. The investigator probably has already contacted your employer and verified your dates of employment and wages
  3. The investigator has full information about your finances including your bank accounts and your mortgage payments
  4. The investigator has a good idea of who lives with you at your house
  5. In most cases, the investigator is not seeking any new information. They simply want you to confirm what they already know.
  6. By speaking with the investigator you will be making self-incriminating statements, which will be used against you later.
  7. And finally, you don’t have to speak with the investigator!

In short, the target letter is a trap and many unsuspected recipients fall for it. The problem is that in many cases individuals did not mean to commit fraud and many times they themselves are victims of unscrupulous representatives of the insurance companies who try to sign up as many clients as possible to maximize their profits. But going after recipients is much easier than going after these powerful insurance companies, and so thousands and thousands of unsuspecting people become targets of fraud investigations.

Much like a police interrogation, anything an accused person says during the course of the interview can be used against them in court. What makes these meetings so perilous is that one innocent mistake, such as a rule that has been construed incorrectly, can result in criminal charges being filed. This is when having an attorney represent you can sometimes make a tremendous difference in the outcome of the investigation, and can many times result in any charges being dropped or a compromise being reached.

Our Delaware Medicaid fraud defense attorneys have handled countless Medicaid fraud investigations and our advice is to never speak with the investigator before contacting an experienced lawyer.

The Results of Medicaid Fraud Investigation

In the Human Resources Administration, responsible for administering the Medicaid program has adopted the policy of reducing fraud by aggressive tactics. If it is determined that a person committed fraud, at best they can be forced to repay the cost of the program to government, which could rise to tens of thousands of dollars. The HRA can pursue a civil law suit against you and obtain judgments against you, file liens against your properties, etc.

At worse, they can be subject to criminal penalties. Unfortunately, while this has always been a possible scenario, it is happening more often now than before. If the case is referred to the District Attorney, you will be arrested and charged with committing a crime of welfare fraud and grand larceny. Potential penalties may include permanent criminal record, jail time, and restitution and fines. Those who are not US citizens may face a host of immigration problems and those who hold professional licenses and certificates may face disciplinary proceedings. We have seen a number of clients who lost their jobs within a week of being arrested.

In some very rare cases, the prosecution may even be handled by the federal government because Medicaid is partially funded by them.

Legal situations involving the federal government are always complex, so attempting to go it alone or with someone with little if any experience in these matters is not a wise move to make.

Whether innocent or guilty of Medicaid fraud, having an attorney who can offer sound advice can help lessen any penalties given or be the deciding factor in proving one’s innocence.

Choosing A Medicaid Defense Attorney

Under Delaware law, any attorney can technically handle a Medicaid fraud defense case and there are many lawyers to choose from. As not all attorneys are created equal, and each handles certain types of cases, you should choose an attorney with the most experience handling cases similar to yours. In addition, you should choose the one you feel most comfortable with. Many times our clients never had to retain an attorney before and the process can be overwhelming as your future is in their hands. We recommend not making such an important decision just based on the Internet presentation of a particular law firm. Anyone is capable of building a nice website full of promises. We believe that the better way is to interview the lawyer and make your decision then. See for yourself if this is the right match and if you feel that this Delaware medicaid fraud lawyer will deliver results. Ask the right questions and you will always see for yourself. Remember that there is not a substitute for experience and honesty. Will the Delaware medicaid fraud lawyer promise you anything you want to hear or will they give you a realistic picture of your case. Have they handled so many of similar cases that they can be said to specialize in them or they are general practitioners who only see similar cases from time to time? These are some of the important things to consider when making your decision.

At The Law Office of John R. Garey, our Kent County Delaware medicaid fraud law firm has built a very impressive track record of handling fraud defense cases, especially Medicaid fraud. We have represented over 750 clients investigated by the Bureau of Fraud Investigations for receiving Medicaid and Family Health Plus benefits to which they were not entitled. We have reached administrative settlement solutions in almost all of these cases, preventing criminal and civil charges.

We also defended numerous cases, which were referred to the District Attorney’s Office. In many of these cases, we were actually able to convince prosecutors not to make arrests and send the cases back to the HRA for a civil resolution. In other cases, we were able to dramatically reduce client’s criminal liability, protect them from immigration, licensing, and other consequences.

Use our efficiency and expertise to your benefit and call us today! Contact us today to speak with a Delaware Medicaid fraud criminal defense lawyer. Dial 302-244-5312 today.