Nurse Sentenced in Medicaid Fraud

According to the Press Republican, a registered nurse has been sentenced for her involvement in ongoing Medicaid fraud totaling over $6,000. Medicaid is an insurance system provided to families and individuals of all ages whose personal financial resources are not able to secure health care. Medicaid is jointly funded by the federal government and by individual states, with the federal government contributing a specified percentage to program costs and allowing states to determine their own provider payment rates.

The defendant had been employed as a private-duty nurse. Private-duty nurses generally provide one-on-one care to patients, typically by traveling to the patient’s home. In these circumstances, the private-duty nurse will submit charges to Medicaid for care provided, either independently or through an employer. In this particular case, the defendant had been charged with submitting 12 separate claims to Medicaid for service dates between July and December of 2012 that listed care not actually provided to the patient. The fraudulent claims came to light when another private-duty nurse was denied reimbursement for services provided because her claim conflicted with a previously submitted claim from the defendant. The defendant offered to repay the nurse that did not receive reimbursement via a personal check, and the mother of the patient involved eventually found several dates of service that had been billed for where no service was actually provided. Further investigation revealed several months of fraudulent claims through which the defendant received thousands of dollars for 48 separate dates of service when no service had been provided.

These types of cases will often be submitted to the Medicaid Fraud Control Unit at the Attorney General’s Office in Albany. In this instance, it was jointly investigated by this office and the New York State Office of the Medicaid Inspector General. After being initially charged in August of 2015 with one count of third-degree grand larceny and 12 counts of first-degree offering a false instrument for filing, the defendant faced up to seven years in state prison as all charges are classified as felonies. The defendant recently pleaded guilty in Saranac Town Court to a misdemeanor offense of second-degree offering a false instrument for filing, resulting in a sentence that included three years of probation and the repayment of the funds the defendant fraudulently received. The defendant has also been excluded from working as a Medicaid provider.

Help Facing White Collar Charges

These types of crimes are typically classified as white collar offenses. If you are facing non-violent criminal charges, it is essential that you secure an experienced criminal defense team because the penalties for such charges can be severe. As in the case above, the defendant received a relatively light sentence compared to what she could have been given. Lighter sentences can often be the result of a successful criminal defense team’s ability to ensure that the government is held to the correct standards in proving certain crimes, as the government is not always able to meet their burden. A criminal defense team can, in this way and others, ensure that a defendant’s rights are protected under the law. If you are facing criminal charges, contact Anelli Xavier’s criminal defense team to schedule a consultation where you can learn more about the charges you are facing as well as the potential consequences for those charges and the related judicial process.