A woman called our office yesterday in a panic. She received a call from an NYPD detective who wants her to surrender on Medicaid fraud charges tomorrow.
The call was not a complete surprise. Three months ago, she received a letter from a Medicaid fraud investigator at the HRA Bureau of Fraud Investigation. The investigator asked her to come to his office for an "interview." He also asked her to bring her tax returns for the past five years, recent pay stubs, and other financial documents.
She thought about getting a lawyer to help her with the investigation, but she wanted to save some money. She also thought the investigator would go easy on her if she cooperated and told the truth. So, she went to the "interview" alone.
When she arrived at the Bureau of Fraud Investigation, she was placed in a small room with no windows. Two Medicaid fraud investigators came in and asked for her tax returns and other financial records. She turned them over.
The investigators left her alone in the room with the door shut for about half an hour. She does not know what they were doing. Based on experience, I know that they probably copied all of her tax returns and financial records. Then they sat down and compared her tax returns to her applications and re-certifications for Medicaid benefits.
When the investigators returned to the room, they were very polite. They returned her tax returns and financial records. They only asked a few questions, such as the address of her residence, the names of everyone who lived with her, the name and address of her employer, whether her signature appeared on the re-certification forms, and whether she actually signed and filed the tax returns she gave them. One investigator asked the questions while the other one took notes.
At the end of the "interview," the investigators said thank you and that they would be in touch.
The next call she received was from the NYPD detective telling her that she had to surrender on Medicaid fraud charges.
Tomorrow, the detective will put her in handcuffs and walk her through the arrest process. She will be fingerprinted and her mug shot will be taken. Then she will wait in a jail cell until they can run her criminal history or rap sheet. If she is lucky, she will remain in the jail cell for six or seven hours. If she is unlucky, she could sleep in the jail cell overnight. At some point she will be arraigned before a judge on felony charges, including Grand Larceny and Welfare Fraud. The judge will set bail, which she will have to post before she will be allowed to go home.
All of this could have been avoided if she had retained a lawyer before she went to see the investigators at the HRA Bureau of Fraud Investigation.
The investigators may have had suspicions about her income before she went to their office. They may have had a good circumstantial case. But they did not have her tax returns, bank records, or recent pay stubs. Without those records, the investigators did not have enough evidence to prove their case beyond a reasonable doubt. But once she turned over her records, they had an open and shut case.
If she had retained a lawyer at the investigation stage, her lawyer would have spoken with the investigators. He would have discovered what evidence they had against her and, more importantly, what evidence they needed. Then her lawyer would have negotiated with the investigators to avoid any criminal charges. She most likely would have paid back some benefits, but she would not have been arrested or charged with serious crimes.
In fact, when a lawyer is involved, more than 95% of investigations at the Bureau of Fraud Investigation are settled with no criminal charges. In most cases, our clients never have to answer any questions. We meet with the investigators on their behalf. Sometimes we convince the investigators to drop the investigation completely. Other times we are able to negotiate a settlement agreement with the investigators. And, in the very rare case when the investigators seek criminal charges, the District Attorney has a very weak case because our client has not turned over any tax returns or made any admissions.
Do not make the same mistake this woman did. If you receive a letter from the HRA Bureau of Fraud Investigation, get an experienced lawyer on your side right away. Your lawyer can often avoid criminal charges and negotiate a settlement that will save you much more money than you will pay in legal fees.
To schedule a consultation with an experienced Medicaid fraud lawyer, call John Howley, Esq. right now at (212) 601-2728.
You can also download our free guide, "How to Survive a Medicaid Fraud Investigation," by submitting this form:
Do Not Ignore a Letter from the HRA Bureau of Fraud Investigation
A letter from the HRA Bureau of Fraud Investigation must be taken seriously. While the vast majority of investigations are settled or dismissed, a significant number result in very serious criminal charges.
If the investigator determines that you lied on your application or re-certifications for Medicaid benefits, then your case may be referred to the District Attorney for criminal prosecution. The possible charges include Welfare Fraud and Grand Larceny.
If convicted, you could be sentenced to up to 15 years in prison. The possible sentence depends on how much Medicaid paid for your benefits.
If Medicaid paid more than $3,000 for your benefits, then you could be charged with Grand Larceny in the Third Degree. That is a class “D” felony and could result in a prison sentence of up to seven years.
If Medicaid paid more than $50,000 for your benefits, then you could be charged with Grand Larceny in the Second Degree. That is a class “C” felony and could result in a prison sentence of up to fifteen years.
Many people assume that Medicaid did not spend much money on their insurance because they did not see a doctor very often. This is not a correct assumption.
Medicaid pays a premium each month to a private insurance company that provides your health insurance. That is why your Medicaid card has the name of a private insurance company on it, such as Healthfirst, HealthPlus, MetroPlus, or UnitedHealthcare. Whether or not you actually used the health insurance, Medicaid paid a premium to that company every month.
The premiums are expensive. For a single person, the Medicaid premiums are between $350 and $500 per month, depending on your age and the years you were covered. For a family of four, the premiums can be more than $1,500 per month. In addition, Medicaid pays a surcharge for certain procedures such as surgery or the delivery of a child in the hospital.
Here’s the bottom line: If you had Medicaid benefits for at least one year, then Medicaid paid at least $3,000 for your benefits. If the investigator refers your case to the District Attorney, you will be charged with felonies that could result in a prison sentence. You could also be fined and ordered to pay back all of the benefits you received.
Do not take any chances. If you received a letter from an investigator at the HRA Bureau of Fraud Investigation, you should consult with a lawyer immediately to protect your rights. As noted above, most cases can be settled by simply paying back some benefits even if you were not 100% truthful on your application and re-certifications. Getting an experienced Medicaid fraud lawyer on your side is the first step in avoiding a catastrophe.
John Howley, Esq. has successfully defended hundreds of clients in investigations by the HRA Bureau of Fraud Investigation. Call him today at (212) 601-2728 to schedule a free and confidential consultation.
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.
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