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Many people are surprised to realize just how often Medicaid fraud occurs in Oklahoma. The problem has become widespread enough that the state created its own Medicaid Fraud Control Unit. The Attorney General’s office heads the unit, and it is their responsibility to investigate all suspected instances of Medicaid fraud. If you or someone you love is facing charges you should speak to an attorney specializing in fraud cases.
An accusation of fraud can be disastrous for your business and personal reputation. Our legal system is supposed to assume innocence until guilt is proven, but it may not always feel like it. If you're facing charges you must speak with a qualified attorney before speaking with anyone else. They can ensure that your rights are protected at every step of the legal process.
Don't answer any questions until you have a lawyer on hand as your answers can and will be used against you. To speak to a fraud expert contact the lawyers at the Law Offices of Adam R. Banner, P.C. today.
Medicaid and healthcare fraud usually come in two varieties: fraud committed by those applying for Medicaid and fraud committed by those providing services to the Oklahoma Medicaid Program (“the Program”). In order to be charged with this crime, any person need only make a claim the person knows to be false, either in whole or in part, by commission or omission in connection with the Program. Participants in the program (as opposed to providers) can also be held criminally liable when they make a false representation or statement while attempting to obtain a service or good provided under the Program.
Specifically, persons that obtain or attempt to obtain services and products through the Program by failing to report—or misreporting—income, personal property, real property, household members, or other material eligibility-factors at the time of application or during the receipt of assistance, will be guilty of a misdemeanor or felony depending on the amount of assistance the person received from the program.
In that vein, if a person causes the Oklahoma Health Care Authority to determine an individual or family eligible for Medicaid or the Insure Oklahoma program, and the assistance received totals under $5,000.00, then the crime will be charged as a misdemeanor with a potential punishment of up to thee (3) months in county jail. If the amount of benefits received as a result of the criminal activity totals $5,000.00 or more, the offense will be charged as a felony with a potential punishment of up to five (5) years in prison. Regardless of the loss amount, Oklahoma’s Medicaid laws also provide for merely assessing an alternative administrative sanction regarding Medicaid benefits in the discretion of the court.
Providers under the Program are subject to potential criminal charges for a much wider range of activities or omissions. Those providing good and services under the Program can be charged when they:
The punishment range for these acts can result in either misdemeanor or felony charges as well depending on the amount gained as a result of the fraud. When the aggregate amount of payments illegally claimed or received is less than $2,500.00, the provider will face a misdemeanor charge and up to one (1) year in county jail. If that amount is $2,500.00 or more, the provider will be charged with a felony and upon conviction face up to three (3) years incarceration.
For the purposes of Medicaid Fraud, a participant or provider shall be deemed to have known that a claim, statement, or representation was false if the person knew, or had reason to know, of the falsity of the claim, statement, or representation. This means that a person need not know the exact nature of the false or fraudulent misrepresentation or omission, so long as the person should have known the nature of the misrepresentation and or omission.
Penalties for Medicaid and healthcare fraud are not limited to only participants receiving assistance and persons providing the assistance. Those individuals that work with the agencies associated with providing benefits to Medicaid recipients can also face criminal liability.
There are situations in which individuals on the “inside” assist providers or recipients in their misrepresentations or omissions by turning a blind eye. Individuals engaged in such activity will usually receive a kickback or some other payment for their assistance. In that scenario, felony charges could be filed. However, that is not always the case.
Consequently, employees of the State Department of Health, the Department of Human Services, and the Oklahoma Health Care Authority who knowingly or willfully fail to promptly report a violation of the Medicaid Program can be charged with a misdemeanor as well.