MEDICAID FRAUD INVESTIGATIONS | FAQ
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How to Survive a Medicaid Fraud Investigation at the NYC Bureau of Fraud Investigation
A Medicaid fraud investigation often begins with a letter from an investigator with the Bureau of Fraud Investigation. The letter may ask you to turn over documents and meet with an investigator for an "interview." By the time you get this letter, the investigator has already gathered evidence against you. The investigator already believes that you have engaged in fraud. Anything you say at this point can and will be used against you. Answers to Frequently Asked Questions (FAQ) |
John Howley, Esq.
1345 6th Ave 2nd Floor New York, New York 10105 (212) 601-2728 |
Why am I being investigated?
The Medicaid fraud investigator has information that suggests you are not qualified for benefits. This information may include payroll records, car registrations, property records, and business records. The investigator may have spoken with your employer, your co-workers, or your neighbors.
What are my rights during the investigation?
You have the right to bring an attorney with you to any interviews or meetings with the investigator. You also have the right to consult with your lawyer before providing any documents or answering any questions.
You have the right to remain silent. You do not have to answer the investigator's questions. If you are a Family Health Plus or Medicaid recipient, your benefits cannot be stopped solely because you refused to answer questions.
Should I answer the investigator's questions?
How you respond to the investigation depends on your particular facts and circumstances. Some questions and requests for documents are appropriate. Others may be improper. Sometimes it makes sense to cooperate with the investigator and negotiate a resolution. Other times you must fight to protect your rights.
You need an experienced Medicaid fraud lawyer on your side to help you make these decisions.
What are the possible penalties and consequences?
Medicaid fraud penalties range from repayment of Medicaid benefits to harsh prison sentences. Some of the possible consequences are:
The Medicaid fraud investigator has information that suggests you are not qualified for benefits. This information may include payroll records, car registrations, property records, and business records. The investigator may have spoken with your employer, your co-workers, or your neighbors.
What are my rights during the investigation?
You have the right to bring an attorney with you to any interviews or meetings with the investigator. You also have the right to consult with your lawyer before providing any documents or answering any questions.
You have the right to remain silent. You do not have to answer the investigator's questions. If you are a Family Health Plus or Medicaid recipient, your benefits cannot be stopped solely because you refused to answer questions.
Should I answer the investigator's questions?
How you respond to the investigation depends on your particular facts and circumstances. Some questions and requests for documents are appropriate. Others may be improper. Sometimes it makes sense to cooperate with the investigator and negotiate a resolution. Other times you must fight to protect your rights.
You need an experienced Medicaid fraud lawyer on your side to help you make these decisions.
What are the possible penalties and consequences?
Medicaid fraud penalties range from repayment of Medicaid benefits to harsh prison sentences. Some of the possible consequences are:
- monetary fines, penalties, and restitution orders
- disqualification or exclusion from receiving Medicaid benefits
- civil judgments and liens on any real property you own
- garnishment of your wages
- criminal prosecution and a possible prison sentence
- suspension or loss of professional licenses
- exclusion from participating in Medicaid as a healthcare provider
- depending on your immigration status, you could be deported
Will the investigator negotiate a settlement?
Depending on the nature of the problem, the investigator may be willing to negotiate a financial settlement to avoid any court cases or criminal prosecution. An experienced Medicaid fraud attorney can help you by negotiating a settlement that reduces the amount owed, by avoiding penalties and interest - and, most importantly, by negotiating an agreement that your case will not be referred for criminal prosecution.
What is Medicaid fraud?
When a recipient of Medicaid or Family Health Plus benefits is investigated, the investigator may suspect that the recipient did not tell the truth or failed to disclose all of their income and assets when they applied for benefits. Some common types of Medicaid fraud involving recipients include:
Depending on the nature of the problem, the investigator may be willing to negotiate a financial settlement to avoid any court cases or criminal prosecution. An experienced Medicaid fraud attorney can help you by negotiating a settlement that reduces the amount owed, by avoiding penalties and interest - and, most importantly, by negotiating an agreement that your case will not be referred for criminal prosecution.
What is Medicaid fraud?
When a recipient of Medicaid or Family Health Plus benefits is investigated, the investigator may suspect that the recipient did not tell the truth or failed to disclose all of their income and assets when they applied for benefits. Some common types of Medicaid fraud involving recipients include:
- providing false information on your application or recertification
- failing to disclose all of your income
- failing to disclose income earned by a spouse or other household member
- failing to disclose rent from a tenant or roommate
- failing to disclose income from a sideline business
- mortgage payments, car payments, or other expenses that are higher than your reported income
- concealing information about your income or assets
- claiming to live in New York City when you actually live someplace else
- re-selling medicine or products obtained with Medicaid benefits
- altering, forging, or obtaining duplicate prescriptions
- receiving treatment or services for which you are not eligible
- allowing another person to use your health insurance card
- receiving and using more than one Medicaid card
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BREAKING NEWSNY Prosecutors Get Tough on Medicaid Fraud
More investigations are resulting in criminal prosecutions, and more prosecutors are charging the most serious felonies. This means a criminal record and possible jail time. Click here to read more.... |
What is the Bureau of Fraud Investigation?
The Bureau of Fraud Investigation (BFI) conducts investigations of individuals and organized groups who are suspected of committing Medicaid fraud. It is part of the NYC Human Resources Administration's Office of Investigation. Investigations by the BFI may result in Administrative Disqualification Hearings, lawsuits to recover money, or referrals to the District Attorney for criminal prosecution. BFI investigators work out of offices at 151 West Broadway in Manhattan.
Who is the investigator?
Medicaid investigators are trained professionals who know how to conduct a thorough investigation. They work together with other investigators who have 10, 20, and even 30 years of experience investigating thousands of Medicaid fraud cases. They are supported by data analysts, financial auditors, and medical experts.