The common conceptual image that many in New York may have of fraud schemes is likely of a high-profile executive who steals millions from a large company and corporation. In reality, however, fraud can occur amongst anyone from any walk of life. Any action meant to financially injure a person or organization perpetuated through deceit and misrepresentations may qualify as fraud. Many such cases may even arise from people supposedly looking to take advantage of procedural holes in systems with which they are familiar.
This is what is being alleged in the case of a Connecticut psychologist. She first came to the attention of authorities after a former employee told them that the doctor continued to receive payments from Medicaid despite frequently canceling appointments with patients. A subsequent investigation into the matter supposedly revealed that the doctor had bilked the state’s Medicaid program of close to $80,000 by billing for hundreds of claims for services with reportedly were never rendered. The doctor was recently arrested by authorities and now faces several felony charges that could leave her facing several years in prison.
Cases involving claims processing can be quite complicated due to the complexities of such processes themselves. Service and benefit providers seemed to be locked in a constant dance of authorizations, denials and appeals. It may be little wonder, then, that accusations of fraud arise from these processes. Evidence may show some to be legitimate, while others may simply be due to poor communication between parties or a lack of understanding of the claims submission process. Those needing assistance in defending themselves from such accusations might find it in the form of a criminal defense attorney experienced in handling these types of cases.