Is Medicaid Fraud Occurring at Your Job or Elsewhere in New York?

Is Your New York Employer or other Medical Provider Guilty of Medicaid Fraud?

New York Medicaid uses taxpayer dollars to provide health care for low-income families and others in need. Healthcare fraud, waste and abuse among New York hospitals, physicians, pharmacists and other medical service and equipment providers cost the government billions in unwarranted expenses each year. Internal information regarding New York Medicaid Fraud is the number one tool the government has to reclaim these stolen taxpayer dollars.

Federal and New York State governments have enacted whistleblower laws to encourage those with valuable information to come forward. These laws provide strong protection against workplace retaliation and a substantial cash reward to those who chose to report fraud. In 2015, the New York Medicaid Fraud Control Unit prosecuted 110 criminal convictions and 65 civil settlements, recovering over $63 million in stolen funds for the State of New York.

Medicaid Fraud is not just stealing taxpayer money. In many cases, it also involves a risk to public safety when healthcare providers act on financial interest rather than the best interest of the patient. The responsibility to report New York Medicaid Fraud falls on all individuals within the healthcare industry. If you have information regarding New York Medicaid Fraud, you may be entitled to a significant cash award. Call today for a free, immediate and confidential case evaluation.

Review the Various Types of Medicaid Fraud

Reporting New York Medicaid Fraud

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What New York Laws Apply to Reporting Medicaid Fraud?

New York Medicaid Fraud is illegal and prosecuted at both the state and federal level. In the State of New York, several laws relate to Medicaid Fraud, including New York PC Article 177 and the New York False Claims Act.

New York Penal Code Article 177 criminalizes New York health care fraud – knowingly and willfully providing (or omitting) materially false information in order to receive payment one is not entitled to. Federal law also regards health care fraud as a crime. The degree of health care fraud charged depends upon the amount of money gained through the illegal acts:

• Fifth degree health care fraud (no profit - a class A misdemeanor)
• Fourth degree ($3000 in one year – class E felony)
• Third degree ($10,000 in one year – class D felony)
• Second degree ($50,000 in one year – class C felony)
• First degree ($1 million in one year - class B felony)

New York False Claims Act (NYFCA), N.Y. Fin. Law Ch. 13 §§ 187-194, enables any person to file a claim against an individual or a company that has obtained or withheld property or funds from the local or state government through fraudulent or false conduct. Under the NYFCA, an individual or company can be charged with health care fraud if they:

• Knowingly presented the government with a false claim for payment
• Knowingly made or used false statements or records to compel government payment of a false claim
• Knowingly used false statements or records to avoid, decrease, or conceal an obligation to pay money to the government
• Possessed government property or money, and delivered or caused to deliver less property or money than the amount detailed on receipt
• Conspired with other individuals or companies to compel government payment of a false claim

Unlike the federal False Claims Act and many other state False Claims Acts, the NYFCA allows for treble damages (double for voluntary, immediate self-reporting of a violation) and carries civil penalties of up to $12,000 per violation (in addition to attorneys’ fees).

Another difference from the federal False Claims Act and other state False Claims Acts is that NYFCA expands liability to fraudulent or false statements, claims or records that are made under the New York tax laws when the entity has made more than $1 million net income or sales AND defrauds the New York state government for over $350,000. This liability includes treble damages and civil penalties.

If you suspect New York Medicaid Fraud or abuse, contact the Medicaid Fraud Hotline right away.

The Centers for Medicare and Medicaid Services (CMS) is working with physicians, pharmacists, sales reps and medical device manufacturers, along with the U.S. Department of Justice, Department of Health and Human Services, Federal Bureau of Investigation and the Office of the Inspector General to discover and prosecute acts of New York Medicaid waste, abuse and billing fraud.

Does New York Law Provide Protection For Those Reporting Medicaid Fraud?

In the state of New York, employer retaliation in response to reporting New York Medicaid fraud is a crime. Several powerful anti-retaliation laws apply to protect private and public employees alike, covered under the New York False Claims Act, New York Whistleblower Laws, and the New York Civil Service Law.

The New York False Claims Act (NYFCA), N.Y. Fin. Law Ch. 13 §§ 187-194, provides significant protections from workplace retaliation for those who choose to report New York Medicaid fraud and punishes the retaliatory actions. Anti-retaliation protections of the NYFCA are significantly stronger than those of the federal False Claims Act, covering both current and former agents, employees and contractors. A qui tam lawsuit does not have to be in place for a person to be protected in the state of New York.

Under the NYFCA, if a person who reports Medicaid fraud is discharged, demoted, suspended, threatened, harassed, blacklisted or in any other manner discriminated against in the terms and conditions of employment, or otherwise harmed or penalized by an employer, or a prospective employer, then that individual is able to file a civil lawsuit against the employer for damages.

A person who suffers retaliation after reporting Medicaid fraud may be entitled to double back pay for any lost wages plus interest, reinstatement of position, “special damages” compensation and attorneys’ fees.

The NYFCA also prohibits retaliation against individuals who obtain or transmit documents, data, correspondence, email or other information that may be in violation of an employment contract or duty to an entity (state, plaintiff, counsel) employed to investigate, potentially file, or file a cause of action under the NYFCA. These individuals are granted immunity from retaliation as long as the possession and transmission of the information is in furtherance of the qui tam action.

Under New York Labor Law § 740, employers cannot retaliate against employees who disclose or threaten to disclose activities, policies or practices that violate laws or regulations which present a substantial and specific danger to the public health or safety or which constitute health care fraud; provide information to or testify before a public body that is conducting an investigation, hearing or inquiry into any violation of law, rule or regulation by the employer; or object to or refuse to participate in an activity, policy or practice that is in violation of a law, rule or regulation. This protection only applies when an actual violation of the law has occurred.

Under New York Labor Law § 741, if the violation involves patient safety and individuals who provide hands-on patient care, an actual violation is not required for the protection.

Under New York Labor Laws, employee protections do not apply unless the individual first reports their concerns to their supervisor and gives the company a reasonable amount of time to make corrections and amendments. There are exceptions to this rule however. This limitation does not apply when improper patient care could result in an immediate threat to a patient or the general public. The limitation also does not apply when the employee believes that reporting a violation will not result in action to amend company procedures or policies.

Under the New York Civil Service Law § 75-b, public employees of the state of New York are protected, in certain cases, from retaliation in response to their disclosing information regarding violations of laws, rules or regulations that create a substantial and specific danger to public health or safety or violations the informant reasonably believes constitutes a violation and reasonably believes to be true.

Anyone suspecting violations in billing, illegal kickbacks, certification violations, false documentation or other forms of fraud involving Medicaid is encouraged to call the Medicaid Fraud Hotline now to discuss your rights and options for a cash reward.

What Cash Awards Are Available for Reporting New York Medicaid Fraud?

State and federal governments know that inside information is the number one means of fighting fraud and recovering taxpayer dollars. The government provides both financial incentive and protection for those willing to come forward and put a stop to illegal use of government funds.

Under the New York False Claims Act (NYFCA), N.Y. Fin. Law Ch. 13 §§ 187-194, an individual with information regarding Medicaid fraud committed against New York State may file a lawsuit to aid the government in its recovery. If the action is successful and the government recovers funds lost to the fraudulent activity, the relator can collect 15-30% of the total recovery amount. The specific amount awarded to the relator is dependent on several variables involved with the case and whether or not the government chooses to intervene.

Under the NYFCA, it is important to act fast. When more than one individual enters a claim regarding the same illegal activities, only the FIRST individual to file is entitled to a financial award.

What is the New York Statute of Limitations on Reporting Medicaid Fraud?

The New York False Claims Act (NYFCA), N.Y. Fin. Law Ch. 13 §§ 187-194, has a 10-year statute of limitations that begins on the date of the violation. In contrast, the federal False Claims Act carries a 6-year statute of limitations.

Under New York Labor Law §740, an employee can file for damages due to retaliation within 1 year of the retaliation incident.

If you have information regarding Medicaid Fraud in the State of New York, contact the Medicaid Fraud Hotline or fill out the online report form. Time is of the essence as you must be the first to act to secure your role as whistleblower and be eligible for a cash award. Call today.

Over $1 Million in Cash Awards for Tips Leading to Government Recovery