When Do Medicaid Investigations Result in Prison Sentences?

The government conducts healthcare fraud investigations literally every day.  In many cases, an experienced attorney can help you negotiate a financial settlement to resolve allegations of questionable or false claims.  In more serious cases, the government may insist on a guilty plea but will agree to a sentence of probation.

Sometimes, however, the government pursues criminal charges and a sentence of five or ten years in prison.

Why does the government settle some health care fraud cases and prosecute others?

A key factor is the nature of the false or fraudulent claims.  Conduct that is obviously intentional, that involves numerous false claims over a long period of time, or that has put patient safety at risk is more likely to result in criminal charges.

Another critical factor is how you respond to the audit or investigation.

The owners of a home health care business in Virginia recently demonstrated what you should not do when Medicare or Medicaid investigators start asking questions.

Irvine Johnston King and Aisha Rashidatu King owned and operated Bright Beginnings Healthcare Services.  They provided in-home personal and respite care and private duty nursing services to Medicaid patients.

Bright Beginnings was audited by the government for allegedly submitting false claims to Medicaid.  The government ultimately found evidence of “phantom billing” or billing Medicaid for services not provided.

During the audit, however, the owners of Bright Beginnings compounded their problems.  According to the government, the owners created false medical records in response to the audit and instructed an employee to lie to Medicaid about the false claims.  They also instructed an employee to convince a patient’s mother to lie to Medicaid in order to cover up the false claims.

Once the government discovered that the owners were obstructing their audit, all hopes of avoiding criminal prosecution were lost.  Ultimately, this case was referred to prosecutors who obtained a conviction on 22 counts of healthcare fraud.  Each of the owners now faces up to 10 years in prison on each count.

How should you respond to government auditors and investigators?  You should consult with an experienced Medicare and Medicaid fraud attorney immediately, before you say anything to investigators.

You have very important legal rights during an investigation.  You have the right to consult with a lawyer.  You have the right to have your lawyer present during any meetings or interviews with investigators.  You have the right to remain silent and to refuse to answer the investigators’ questions.

An experienced Medicaid and Medicare fraud lawyer can help you understand the possible charges and consequences, develop a strong and aggressive defense, and negotiate with the government to avoid or reduce the charges and penalties.

If you are under investigation or have been charged with a crime, consult with an experienced Medicare and Medicaid fraud lawyer immediately.  To arrange a free and confidential consultation, call John Howley, Esq. at (212) 601-2728 or click here to reach our office via email.

John Howley, Esq.

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