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Clients often ask why they were singled out by the NYC Bureau of Fraud Investigation for a Medicaid or Family Health Plus fraud investigation. The answer is usually one or more of the following red flags.
Change in Income. If you qualified for Medicaid or Family Health Plus Benefits when you first applied, but you later started a new job or received a raise, the Bureau of Fraud Investigation will often ask your employer for payroll records to show how much you earned each month when you were receiving benefits. The investigator may be targeting you for an investigation if your income increased above the eligibility limits.
Unreported Family Members. The application and recertification forms asked you to disclose everyone who lives in your "household." The forms also asked you to disclose the parents of any children living with you, whether or not you are married to that person. Investigators may have discovered that additional people are living with you by cross-referencing public records such as driver's licenses, or by visiting your home, talking to neighbors, and taking pictures of people and cars at your residence.
Mortgage Payments. Mortgages are filed with the county clerk and are public records. If your mortgage payments are high compared to your income, the investigator may question how you can afford to pay the mortgage, real estate taxes, and utilities based on the income you reported on your application and recertification forms.
Rental Income. If you own real estate and have tenants, the investigator may question how much rent you are receiving from tenants. Rental income may put you over the eligibility limits for benefits, even if your salary does not.
Car Ownership. You are allowed to own a car and receive benefits under Medicaid and Family Health Plus programs. But if your car payments are high compared to your reported income, the investigator may question how you can afford the car payments on your income.
Residence Outside New York City. Maybe you lived in New York City when you first applied for benefits, but you later moved to Long Island or New Jersey. If so, you are supposed to stop receiving benefits from New York City and apply for benefits where you live. The investigator can find out where you live from a number of public records including your driver's license, car registration, and car loan financing statements. The investigator may also go to your old NYC address to find out if you really live there.
Employer Health Insurance. If your employer offers health insurance, you are required to get the insurance through your employer and not through Medicaid or Family Health Plus. This is true even if you must pay part of the insurance premium for the employer's health insurance plan.
Business Ownership. Publicly-available records can disclose whether you own a business. The investigator has a number of ways to determine how much money the business generates. If those numbers are higher than the income you reported on your application and recertification forms, the investigator may question where the money went.
What Should You Do?
If you received a letter from the Bureau of Fraud Investigation, then you should consult with an experienced Medicaid fraud lawyer to determine whether or not you have a problem. Your lawyer can review your financial records and help you decide how to respond to the investigation.
Sometimes your lawyer can convince the investigator that you were, in fact, eligible for benefits for all or part of the time period in question. Other times, your lawyer can help you avoid a lawsuit or criminal prosecution by negotiating a settlement with the investigator. And in some cases, you should exercise your right to remain silent to avoid incriminating yourself.
An experienced Medicaid fraud lawyer can help you make these decisions by reviewing your financial records and discussing your specific situation with you.
To schedule a free and confidential consultation with an experienced Medicaid fraud lawyer, call John Howley, Esq. at (212) 601-2728, or complete and submit the free consultation request form on this page.