Medicaid fraud happens, and federal courts in New York may become home to civil fraud lawsuits initiated by a U.S. attorney. On Nov. 24, 2021, the Southern District of New York issued a press release announcing a civil fraud lawsuit against a non-profit organization and two individuals involved with the entity.
A federal lawsuit raises attention to Medicaid fraud
The lawsuit focuses on diverting Medicaid funds intended for a non-profit to a for-profit enterprise. The lawsuit also makes mention of excessive salaries and consultation fees. Allegedly, from 2010 to 2019, millions of dollars in Medicaid funds went to cover “inflated…Medicaid reimbursement rates.”
Civil fraud cases do not reflect criminal proceedings. Such cases seek to recover “federal funds obtained through fraud.”
If someone procured $1 million through fraudulent health care billings, a U.S. attorney might sue to get the money back. Civil cases do not require guilt beyond a reasonable doubt, as a preponderance of the evidence stands as the bar in a civil suit.
Criminal matters related to health care fraud
A doctor who falsely bills the government for Medicare and Medicaid funds could deal with more than a civil fraud lawsuit. A U.S. attorney might also pursue criminal charges for health care fraud. Criminal charges have a higher threshold of proof than civil ones, but the consequences of a guilty verdict might be far harsher than a civil judgment. The accused could face significant prison time.
Viable defenses to the charges could work in the accused’s favor. If the defendant’s “fraud” involves errors and mistakes and not criminal intent, the prosecutor’s case may fall apart. Any violations of the accused’s rights by law enforcement could render evidence inadmissible, thus a guilty verdict might not be a foregone conclusion.