A letter from the NYC Bureau of Fraud Investigation is usually your first indication that you are under investigation for Medicaid fraud. You should respond to that letter the way you would respond to any serious criminal investigation – by getting an understanding of your legal rights before you say anything.
Failing to respond properly could result in a judgment against you for tens of thousands of dollars in restitution, felony criminal charges, exclusion or disqualification from participating in the Medicaid program in the future, loss of professional licenses and, if you are not a U.S. citizen, deportation.
Your case does not have to end that way. Here are some very important rights that you should exercise before talking to anyone at the Bureau of Fraud Investigation.
Your Right to an Attorney
You have the right to consult with an attorney, to have an attorney present whenever the investigators try to “interview” (that is, interrogate) you, and to have the attorney communicate with the investigators on your behalf. Your attorney can ask questions, get evidence from the investigator, develop your defenses, explain your side of the story, and negotiate with the investigators to avoid criminal charges.
Many clients ask, “But won’t the investigator think I’m guilty if I hire an attorney?” Stop. The investigator already believes that you are guilty. The investigator already has at least some evidence to prove that you are guilty. Having an attorney shows that you are taking the investigation seriously and often makes the process easier for everyone involved – you and the investigator.
Your Right to Review the Evidence Against You
My first step in any Medicaid fraud investigation is to ask the investigator to provide me with certain documents. At the Bureau of Fraud Investigation, I always ask for my client’s application and re-certifications for Medicaid benefits. In most cases, the application and re-certifications were signed three, four, five or more years ago. My client should not guess. We need to know exactly what is written on the documents before we say anything to the investigators.
My second step is to ask the investigator what the problems are. Sometimes the investigator is looking at one issue, while my client was concerned with a different issue. We do not want to start talking about our defenses until we know what the problems are.
Your Right to Remain Silent
Medicaid is not allowed to terminate your benefits just because you refuse to answer a Medicaid fraud investigator’s questions. You have the absolute right to remain silent.
Whether or not you provide information to the investigator will depend on a number of factors. What evidence do they have against you already? Do they intend to refer your case to the District Attorney for criminal prosecution? Are they willing to consider a financial settlement with no criminal charges? Are their questions legitimate? Or are they asking for documents and information that you are not required to provide?
If the investigator intends to refer your case for criminal prosecution, then there is no reason to give him any information. Any information you provide will be used against you. On the other hand, you may want to cooperate with the investigator if it will help settle the investigation without criminal charges.
An experienced Medicaid fraud lawyer can talk directly to the investigator, protect your rights, get the evidence you need, develop a strategy, decide whether or not to cooperate with the investigation and, in most cases, negotiate a settlement that avoids criminal charges . . . even if you are guilty.
The first step is an initial consultation. To schedule a free and confidential consultation with an experienced Medicaid fraud attorney, call John Howley, Esq. today at (212) 601-2728.
Many clients ask, “Why is the Bureau of Fraud Investigation investigating me for Medicaid fraud?”
Obviously, a major factor is your income. If your income increases over time and you fail to disclose the increases on your re-certifications for Medicaid benefits, then you will be investigated at some point.
A less obvious factor is your expenses. Investigators will start investigating you if your expenses – such as for a home or car – are higher than your reported income can support.
Listed below are some of the major red flags that can result in a Medicaid fraud investigation. If any of these apply to you, then you should call John Howley, Esq. at 212-601-2728 to schedule a free and confidential consultation before you speak to the investigator.
Real Estate Ownership
Medicaid is designed for families and individuals who live at or just above the poverty level. Most people who receive Medicaid benefits can barely afford to pay their rent, let alone make a down payment on a home. Investigators have access to a number of public records such as deeds and mortgages that show who owns a property, how much was paid for the property, and how much it costs for monthly mortgage payments and real estate taxes. If they discover your name on any of these documents, they will investigate you.
A New or Expensive Car
Medicaid fraud investigators can easily check public records to find out whether you own or lease a car, and even how much you pay every month. Car titles and registrations are available in public records. If you financed the car through a bank loan or lease, the bank or financing company filed a public record showing how much the car is worth and how much you are required to pay. If your name appears on any of these records, the investigators will question how you can afford the car.
An Address Outside the City of New York
New York City provides the most generous Medicaid benefits in the country. But those benefits are available only to people who reside within the five boroughs. The Bureau of Fraud Investigation regularly checks the addresses of Medicaid recipients through a number of different databases. If you have an address outside New York City in any of your records, that can trigger a Medicaid fraud investigation.
Your children are listed on your Medicaid application and re-certifications. Medicaid investigators use that information to determine where your children are attending school. If your children attend a school that is not in the same area as your home, or if your children attend a private school, that can trigger a Medicaid fraud investigation.
Employment by New York City of State Agencies
You are not eligible for Medicaid benefits if you are able to obtain health insurance from your employer – even if you have to pay part of the premiums and even if your share of the premiums is expensive. Since employees of New York State and City agencies are eligible for health insurance for themselves and their families, Medicaid is constantly matching its list of Medicaid recipients with databases of State and City employees. If you or someone who lives with you works for a New York State or City agency, you will be investigated for Medicaid fraud.
Tenants, Boarders, and Undisclosed Family Members in the Home
A large number of investigations are started because the Bureau of Fraud Investigation discovers that people live at the same address as you, but they are not listed as part of your household on your Medicaid application or re-certifications. The investigators will want to know if they are paying you to live there as tenants or boarders. If they are relatives or friends who live with you, the investigators will want to know whether they have an income and whether they contribute anything towards the household expenses.
Business Filings and Special Licenses
The Bureau of Fraud Investigation will often start an investigation if they discover that you or someone in your household owns a business or has a business-related driver’s license (such as a commercial, taxi, livery, or limo license). This results in a very complicated and potentially dangerous investigation. For example, some deductions, such as for depreciation, are perfectly legitimate for tax purposes, but are not allowed for purposes of determining your eligibility for Medicaid benefits.
Get Help Right Now
It is often possible to avoid criminal charges – even if you are guilty – by convincing the investigator that you did nothing wrong or by negotiating a settlement. But you must keep in mind that the Medicaid rules are very complicated, and anything you say can and will be used against you. That is why you should consult with an experienced Medicaid fraud attorney before you say anything to the investigator. Your attorney can negotiate with the investigator on your behalf and, in most cases, you will never have to answer any of their questions.
To schedule a free and confidential consultation, call John Howley, Esq. at 212-601-2728 today.
The first question most clients ask is: “Will I go to jail?” When it comes to Medicaid fraud, that is a possibility. Fortunately, it is not the only possibility.
What will happen in your case depends on your specific facts and circumstances. You must begin with an analysis of the evidence by an experienced Medicaid fraud attorney.
Some cases are defendable. The investigators may not have all the facts, the evidence against you may be weak, or the witnesses may lack credibility. If the government has a weak case, then your lawyer should make every effort to defeat the charges. The best time to do that is during the investigation stage, before any criminal charges are filed. In many cases, we have convinced investigators to drop their investigations or settle the matter with no criminal charges at all.
In other cases, the evidence is so strong that there is no real defense. However, an experienced defense lawyer can still help you avoid the most serious consequences.
Even if you are guilty, you have a very good chance of avoiding a jail sentence if you have never been arrested before, the amount of money involved is relatively small, and you are able to make restitution (that is, to pay back money). The prosecutor and judge may allow you to plead to a reduced charge, such as a misdemeanor with no jail time. You may be sentenced to probation, a fine, a conditional discharge, or community service.
In some cases, we have been able to convince the prosecutor to dismiss all criminal charges even when our client admitted that they were guilty as charged. The outcome always depends on the specific facts of your case.
We have helped hundreds of people just like you defend against Medicaid fraud claims. We have convinced investigators to drop their investigations or to settle cases without any criminal charges. In more difficult cases, we have convinced prosecutors to reduce charges and agree to no jail time for our clients. We have also taken cases to trial and convinced the jury that our client did not commit Medicaid fraud.
You should begin right away with a free and confidential consultation to discuss your specific facts and circumstances. Do not delay. Medicaid fraud charges are like a cancer. The sooner you take action to address the problem, the better are your chances of a good outcome. Call John Howley, Esq. at (212) 601-2728 today to schedule a free consultation.
If you received a letter from the Bureau of Fraud Investigation at 151 West Broadway in Manhattan, then you are a target of a Medicaid fraud investigation. You may be facing very serious legal consequences that could include criminal charges. Anything you say to the investigators can and will be used against you.
Before you do anything else, you should consult with an experienced Medicaid fraud lawyer to understand your options. John Howley, Esq. has more than 25 years of experience representing hundreds of individuals, just like you, before fraud investigators. To schedule a free and confidential consultation with Mr. Howley, call him at 212-601-2728 before you talk to the investigators.
In the meantime, here is some basic information about the Bureau of Fraud Investigation and their “interview” process at 151 West Broadway.
What is the HRA Bureau of Fraud Investigation at 151 West Broadway?
The Bureau of Fraud Investigation is part of the NYC Human Resources Administration (HRA). It is responsible for investigating Medicaid fraud in New York City. The investigators at 151 West Broadway are responsible for investigating thousands of cases of Medicaid fraud every year. They are very experienced and aggressive investigators.
Why am I being investigated by the Bureau of Fraud Investigation?
Most Medicaid fraud investigations begin for one or more of the following reasons: (1) your household income is too high; (2) you do not live permanently in New York City; or (3) you can obtain health insurance from your employer.
Income Too High: Most Medicaid fraud investigations begin because the investigators discovered that your total household income is too high. The Medicaid rules require that you “re-certify” for benefits every year. In that re-certification, you must disclose all of your income and all of the income of anyone else who lives in the same household with you. This includes employment income, spousal income, financial assistance you receive from family and friends, unemployment benefits, and income from a business or sideline such as selling on eBay or Amazon.com. If you are married, then you must also disclose all of your spouse’s income, even if you do not live together.
Residence Outside New York City: New York City has one of the most generous Medicaid programs in the entire country. As a result, some people are tempted to keep their New York City Medicaid benefits even if they move outside the City. This is a major problem. You are not allowed to collect Medicaid benefits from New York City unless you live in one of the five boroughs. Your permanent residence (usually the residence that you list on your tax returns and other tax documents) is what counts.
Employer-Provided Health Insurance: You are not allowed to receive Medicaid benefits if you could receive health insurance from your employer. It does not matter if your employer requires you to pay part of the health insurance premiums or if the premiums are too expensive. If your employer offers health insurance, then you and your family do not qualify for Medicaid benefits.
What does the Medicaid fraud investigator know about me?
The investigator may know more about you than you do. By the time you receive their letter, the investigator has already visited your home and taken pictures. If you or anyone who lives with you owns a car or home, the investigator already has the car registration and property documents showing how much the car or home are worth, how much they cost, and what the monthly payments are. If you or someone who lives with you works for someone else, the investigator already has all of the payroll records.
What will happen if I was not qualified for benefits?
If the Medicaid fraud investigators can prove that you intentionally lied on your re-certifications, then they will send your case to the District Attorney for criminal prosecution. The District Attorney usually brings felony charges that can result in prison sentences of up to five years. On the other hand, if the investigators cannot prove that you acted intentionally, or if you simply made mistakes, then they will offer you a chance to settle the case by paying back benefits you received when you were not eligible.
How should I respond to a letter from the Bureau of Fraud Investigation?
You should immediately seek help from a Medicaid fraud lawyer. If you go to 151 West Broadway for an “interview” with the investigators, you will be placed in a small, windowless room with two investigators. They will close the door. Then, one of the investigators will cross-examine you while the other one takes notes. They are not there to help you. They are there to gather evidence. Anything you say to the investigators can and will be used against you.
How can an experienced Medicaid fraud lawyer help me?
The process begins with a free and confidential consultation. John Howley, Esq. will personally review your unique situation. He will help you understand the issues, develop a strategy, and decide how best to respond to the investigators. If you decide to retain Mr. Howley, then he will meet personally with the investigators in an effort to negotiate a resolution and avoid criminal charges. In most cases, you will never have to speak with the investigators or answer any questions.
How do I get started?
Call John Howley, Esq. at 212-601-2728 to schedule your free and confidential consultation.
Many people are surprised that the penalties for Medicaid fraud are so severe. They do not realize that Medicaid applications are signed under penalty of perjury. They do not understand that making a false statement on a Medicaid application is a felony.
As a result, many people are shocked when a Medicaid fraud investigator calls them, or contacts their employer, or sends them a letter asking them to come in for an "interview." They are even more shocked when they learn that they can go to prison for up to five years for lying on a Medicaid application.
In New York City, the letter comes from a Medicaid fraud investigator with the Bureau of Fraud Investigation at the NYC Human Resources Administration. The letter usually asks you to come to 151 West Broadway or 250 Church Street for an "interview." You are asked to bring your tax returns and sometimes other financial and personal records.
Do NOT ignore this letter. If you respond properly to this letter, you can usually avoid serious consequences. But if you ignore the letter, the investigator will send your case to the District Attorney, and you will end up in handcuffs.
Understand that this letter is NOT the beginning of the investigation. This is the end of the investigation. The investigator already thinks you are guilty. They are going to decide whether or not to prosecute you. Anything you say to the investigator at this point can and will be used against you.
Most of all, do NOT lie to the investigator. They already know a lot about you.
The investigator already has all of your applications and re-certifications for Medicaid benefits.
The investigator already knows where you work, whether you own a business, and how much you earn. If you work for a company, the investigator already has your payroll records.
The investigator already knows where you live, who lives with you, whether you own or rent your home, and how much you pay every month for your rent or mortgage. The investigator has been to your home and has pictures of you and the people who live with you.
The investigator already knows if you own or lease a car, how old it is, and how much you pay for it every month.
The investigator already knows where your bank accounts are, and how much money is in those accounts. The investigator also has your credit report showing how many credit cards you have and how much you pay every month on those credit cards.
The investigator does not need you to come in for an "interview." They could send your case to the District Attorney for criminal prosecution right now. The "interview" is both an opportunity and a trap. If you handle the "interview" properly, the investigator may let you negotiate a settlement -- even if you lied on your Medicaid application. On the other hand, the investigator will try to get you to admit that you are guilty.
What should you do?. You should begin by bringing the letter and your tax returns to an experienced Medicaid fraud lawyer. Your lawyer can review your situation, identify the problems, and help you develop a strategy to avoid criminal charges.
To schedule a free and confidential consultation with an experienced Medicaid fraud lawyer, call John Howley, Esq. at (212) 601-2728.
A young woman was terrified when she received a letter from the NYC Human Resources Administration, Bureau of Fraud Investigation. A Medicaid fraud investigator wanted her to come in for an "interview" and to bring her tax returns and other financial records with her.
She was terrified because she knew why the Medicaid fraud investigator sent her the letter. She had lied about her income on her Medicaid application. She was even more terrified because she is a nurse. She couldn't sleep thinking about what this meant. She could go to jail. She could lose her license. She could be excluded from the Medicaid program and not be able to work for five years.
She was so terrified that she did nothing. She ignored the letter. Until one day, a few months later, an NYPD detective showed up at her job. He told her that she had to appear at the District Attorney's office the next day to surrender.
When she arrived at the District Attorney's office, the detective arrested her, placed her in handcuffs, and processed her. Her mug shot and fingerprints were taken. She was placed in a jail cell with other prisoners to wait for a judge. It was humiliating.
But that was just the beginning. When she appeared before the judge, she was charged with serious felonies including fraud and grand larceny. She faced up to five years in prison, plus fines and restitution of almost $100,000.
Her case did not have to turn out this way. I have represented hundreds of people who received letters from Medicaid fraud investigators at the HRA Bureau of Fraud Investigation. In almost every case, my clients never had to speak to the investigators. After reviewing my client's tax returns and other records, I went to the interview for them. I negotiated with the investigators for them. And in almost every case, the investigators agreed to a financial settlement with no criminal charges, no lawsuits, and no impact on my client's credit record.
If you received a letter from the HRA Bureau of Fraud Investigation, call John Howley, Esq. immediately at (212) 601-2728 to schedule a free and confidential consultation.
Two of my clients had exactly the same problem at the Bureau of Fraud Investigation, but with very different results.
One client, I’ll call her Sarah (not her real name), was working part time when she first applied for Medicaid. Her income was low, so she qualified for benefits. A few months later, she was hired full time. She did not notify Medicaid that her income had increased. Worse, when she received re-certification forms, Sarah sent them back every year without telling Medicaid that her income had increased.
Three years later, Sarah received a letter from the Bureau of Fraud Investigation. The investigators wanted Sarah to come in for an “interview,” and they wanted to see her tax returns and bank statements. Sarah immediately came to my office for a free and confidential consultation.
After going through Sarah’s tax returns and bank statements, I went to meet with the investigators. Sarah did not come with me, so the investigators could not ask her any questions. I did not bring any documents. Before saying or giving anything to the investigators, I wanted them to tell me what they already knew.
We were able to settle the investigation by having Sarah pay back some of the benefits she received after her income increased. The investigators agreed to a small monthly payment with no penalties and no interest.
Another client, I’ll call her Linda (not her real name), was not so lucky. Linda also applied for Medicaid when she was working part time, and she continued receiving benefits after she became a full-time employee. But when Linda received the letter from the Bureau of Fraud Investigation, she went to see the investigators by herself.
Two investigators put Linda in a small room with no windows. They demanded to see her tax returns and bank statements. Then they interrogated her for an hour. When they were done, the investigators sent Linda’s case to the District Attorney for criminal prosecution. Linda did not call me until after she was arrested and charged with a felony for stealing Medicaid benefits.
If you received a letter from the Bureau of Fraud Investigation, you should consult with a lawyer to protect your rights. The initial consultation is free and confidential.
Schedule a consultation today by calling our law offices at (212) 601-2728.
Every year, more than 5,000 New Yorkers receive letters from the NYC Bureau of Fraud Investigation. The letters ask you to come in for an "interview" with a Medicaid fraud investigator. You are also asked to bring documents, such as tax returns and bank statements.
The first question most clients ask is: "Do I need a lawyer?"
The second question most clients ask is: "If I hire a lawyer, won't the investigator think I'm guilty?"
Let's understand something from the start. If the investigator sent you a letter, then the investigator already thinks you are guilty.
The investigator already has your payroll records from your current and former employers, your credit report, and other documents showing your assets and income.
The investigator knows where you live, whether you own or rent your home, how much you pay each month for rent or mortgage payments, who lives with you, and how much they earn. Two investigators have sat outside your home watching to see who goes in and out. They have taken photos of your home and its residents, and they have spoken with your neighbors.
If you go to their office for an "interview," you will be placed in a small, windowless room with two investigators. One investigator will interrogate you, while the other one writes down everything you say. Anything you say can and will be used against you. It will be a very intimidating experience.
Based on your interview, the investigators will decide what to do next. They can demand that you pay back thousands of dollars in benefits. Or they can send your case to the government's lawyers, who will sue you for tens of thousands of dollars. Or they can send your case to the District Attorney, who will charge you with felonies and have you arrested.
Here's the good news: You do not have to face the investigators alone. An experienced Medicaid fraud lawyer can contact the investigators on your behalf and find out why they have targeted you. Your lawyer can present evidence and negotiate with the investigators on your behalf. In many cases, our clients never have to answer any questions from the investigators.
The first step is understanding the specific facts of your case. We offer a free and confidential consultation to help you understand how to respond to the investigator. We will review your records, explain how the process works, and help you develop a strategy.
Call our office today at (212) 601-2728 to schedule a free and confidential consultation with an experienced Medicaid fraud lawyer.
Responding properly to a letter from the NYC Bureau of Fraud Investigation is critical. Failing to respond -- or failing to respond properly -- can result in serious consequences.
The penalties may include paying tens of thousands of dollars in restitution plus interest, fines and penalties. If the investigator decides to send your case for criminal prosecution, you could be sentenced to prison and, if you are not a U.S. citizen, you could be deported.
The biggest mistake you can make is ignoring the investigator. Burying your head in the sand will not solve your problem. You failure to respond will lead the investigator to conclude that you are guilty and unwilling to cooperate. Under those circumstances, the investigator will have no choice but to start legal proceedings against you.
At the same time, you should not answer any questions or turn over any documents to the investigator before consulting with a lawyer. Anything you say can and will be used against you.
So, what should you do if a Medicaid fraud investigator contacts you? Be polite and professional. Respond promptly to the investigator. Let them know that you want to cooperate. Then get professional legal help and advice.
If you are contacted by letter, bring the letter to a lawyer and get advice on how to respond. Make sure that you or your lawyer responds by the date in the letter, even if it is only to ask for more time.
If you are contacted by telephone or in person, politely tell the investigator that you cannot talk right now. Ask for their name and telephone number. Tell them that you will get back to them. Then bring the investigator's contact information to a lawyer for advice on how to respond.
Responding promptly to Medicaid fraud investigators is the first step to avoiding a catastrophe. In many cases, any problems you have can be resolved without lawsuits or criminal prosecutions. But you must have your lawyer communicate with the investigator as soon as possible, before the investigator decides to take legal action against you.
To schedule a free and confidential consultation with an experienced Medicaid fraud lawyer, call John Howley, Esq. at (212) 601-2728.
A woman called my office today with a typical Medicaid problem. She applied for Medicaid during a period of unemployment, and then she did not terminate her Medicaid benefits after she found a new job.
In most cases like this one, an experienced Medicaid fraud lawyer can negotiate a settlement that avoids any lawsuits or criminal charges.
Unfortunately, this woman made a big mistake. As a result, she has been arrested and charged with a serious crime.
Her mistake was meeting with the Medicaid fraud investigators alone. The investigators did not ask her many questions. They just wanted her to admit that she signed the application for Medicaid benefits, and that she continued to receive Medicaid benefits after her income increased.
Based on her admissions, the investigators referred the case to the District Attorney for criminal prosecution. The District Attorney charged her with a felony, Grand Larceny in the Third Degree, because the total amount of Medicaid benefits she received exceeded $3,000. If convicted, she faces possible prison time and a permanent criminal record.
All of this could have been avoided if she had simply consulted with an experienced Medicaid fraud lawyer. Her lawyer would have met with the investigators on her behalf. Without her admissions, the investigators would not have had such a strong case. They would have been much more likely to negotiate a settlement with no criminal charges.
If you receive a letter from Medicaid fraud investigators, remember this: The investigators are not on your side. They already believe that you have done something wrong. Their main objective is to develop the evidence against you.
Consult with an experienced Medicaid fraud lawyer before you speak with the investigators.
To schedule a free and confidential consultation, call John Howley, Esq. at (212) 601-2728.