What Happens at Bureau of Fraud Investigation Interviews

When the Bureau of Fraud Investigation believes someone has committed Medicaid fraud, they send the person a letter asking them to come in for an “interview.”  The letter also asks the person to bring their tax returns, bank statements, and other financial records.

If you appear for an interview, you will be placed in a small room with two investigators.  Most of the rooms have no windows.  The investigators will close the door and start asking you questions.  One investigator will ask the questions while the other one will write down what you say.

The investigators will ask where you live, who lives with you, where you work, how much you earn, and how much you have in the bank, mutual funds, or other investments.  They will ask about any cars or property you may own.  They will ask about your expenses for housing, utilities, food, child care, transportation, clothing, etc.  If your expenses are more than your income, they will question how you can afford to support yourself.

What the Investigators Already Know

The investigators already know most of the answers to these questions.  They already have your applications for benefits.  They have property records, car registrations, payroll and business records.  They have been to your home, and they may have pictures of you and the people who live with you.

The investigators have already found something that appears to be inconsistent with your applications for health insurance benefits.  Sometimes there is an innocent explanation for the inconsistency.  The problem is, the investigators already think you are guilty.

Turning Over Tax Returns and Bank Statements

If you turn over your tax returns and bank statements, the investigators will leave the room to make copies.  They will be gone for a while, because they will review your tax returns and bank statements line by line.  They will look for income, bank deposits, and transfers that are inconsistent with the income and assets you claimed on your applications for benefits.  They will look for checks, withdrawals, and other payments that are inconsistent with the expenses you claimed.

In other words, the investigators will use anything you say and anything you give them to bolster their case against you.  If they conclude that you did not tell the truth on your applications for benefits, the investigators may refer your case to the City’s lawyers who will file a lawsuit against you.  If the investigators believe that you intentionally made false statements on your applications for benefits, they may refer your case to the District Attorney for criminal prosecution.

What Should You Do?

You must respond to the investigator’s letter, but you do not have to face the investigators alone.  Indeed, you may not have to face the investigators at all.  If you retain an experienced Medicaid lawyer, your lawyer can meet with the investigators on your behalf.

Your lawyer will review your tax returns, bank statements, and other financial records before he meets with the investigators.  Once he understands your situation in detail, your lawyer will meet with the investigators to discuss a resolution of the investigation.  In many cases, an experienced lawyer can negotiate a settlement with the investigators to avoid any lawsuits or criminal prosecutions.

To schedule a free consultation with an experienced Medicaid lawyer, call John Howley, Esq. at (212) 601-2728.