FREQUENTLY ASKED QUESTIONS

Below are some of the most frequently asked questions from our Medicaid fraud clients:

What should I do if I received a letter from NYC HRA, Bureau of Fraud Investigations (BFI)?

If you received the HRA investigation letter do not consider going there by yourself. Remember that anything you may disclose during the meeting can be used by investigator against you. When investigators call you in for an interview, they already assume that you have committed Medicaid Fraud. Seek help of an experienced attorney who will represent you in your Medicaid Fraud investigation case and will take the burden off of your shoulders. Call the Law Office of Inna Fershteyn right away (718) 333-1233 before speaking with investigators. We may be able to obtain an administrative resolution for your Medicaid Fraud investigation case before it is referred to the District Attorney’s office.

Why was I picked for Medicaid Fraud?

Most Medicaid Fraud cases in NYC are flagged because of the recipients’ failure to disclose the full household income on their application/recertification or failure to update the agency about the increase in income. There are many different databases available to investigations where they can obtain information regarding Medicaid recipient’s income, household structure, and other evidence. If the information you provided on your application/recertification does not match the information listed in those databases, you will become a target of Medicaid Fraud Investigation.

What can be the outcome of this Medicaid Fraud Investigation?

If you are investigated for Medicaid Fraud, you can face a number of legal consequences including:

  • Monetary fines, penalties, and restitution orders
  • Disqualification from receiving Medicaid benefits
  • Civil judgments and liens on any real property you own
  • Garnishment of your wages
  • Criminal prosecutions and a possible prison sentence
  • Suspension or loss of professional licenses
  • Exclusion from participating in Medicaid as a provider
  • Depending on your immigration status, you could be deported.

Our experienced attorneys can help you to avoid such harsh consequences and minimize the restitutions payments.

 

I Received a Letter from the HRA Bureau of Fraud Investigations, What Should I Do?

 

What Are My Rights If I Am Being Investigated for Medicaid Fraud?

The Medicaid fraud HRA letter states that you have a right to bring an attorney to an initial Medicaid fraud meeting. Prior to this meeting, you can meet with your Medicaid fraud attorney about your rights and submit any necessary documents for review.

If there is any potential criminal prosecution, you can exercise your right to remain silent. You do not need to respond to any of the investigator’s questions. If you are a Medicaid recipient, your benefits will not be discontinued because of such actions. However, we advise that you do not go to the meeting with an investigator on your own. You can seriously undermine your case.

What Process Do the NYC HRA Investigators Follow Specifically And What Can I Expect at Each Step?

1) The NYC HRA investigators begin an investigation because of a triggering event. A triggering event for a HRA investigation could include:

  • Bank Records
  • Property Records
  • School Records of Your Children
  • NYS Tax Returns
  • Federal Tax Returns
  • A phone call reporting Medicaid fraud

2) You will receive a request from the HRA and state that authorizes information to be released to the HRA, Bureau of Fraud Investigation. The investigators will have the opportunity to conduct field visits which consist of taking photos of your house, your cars, and your workplace. After these field visits are completed, the investigators will send a target letter asking you to submit all documentation to the investigators. This target letter will request various documents which will analyze your eligibility for Medicaid. Unfortunately, many individuals think Medicaid fraud investigation isn’t a big deal and that they can just explain their situation to the investigator. However, the reality of the situation is that investigators are only there to expose fraud. The investigator is not your friend and his job is to convict you, not work out a deal with you.

3) An experienced Medicaid fraud attorney will always want to review and analyze your CDR’s. A CDR is a form that lists all payments made by the Provider for the recipient in the Medicaid fraud case and it details each claim.

4) Finally your Medicaid fraud attorney will meet with the HRA investigator, most often without your presence. Depending on the circumstances of your case, you may have to interview with an HRA investigator. From here, you will review your document, discuss any settlement options, and/or give in any evidence that may dismiss your case.

To speak with the best NY Medicaid fraud attorney, please call us at (718) 333-1233.

What is the New York Medicaid Fraud Control Unit (MFCUs) and How Does It Operate?

The New York Medicaid Fraud Control Unit (MFCU) is a single law enforcement entity that is made up of investigators, auditors, attorneys, and administrative staff. Its sole purpose is to combat Medicaid fraud in New York. The MFCU has the right to investigate Medicaid fraud if it meets two conditions. The first condition requires the consent of the Office of Inspector General of the US Department of Health and Human Services. The second condition requires that the investigation must relate to Medicaid. The MFCU has the statewide authority to investigate, penalize, and prosecute individuals involved in criminal welfare cases.

What Types of Medical Providers Are Targeted for Fraud Charges?

Many medical providers are targeted for fraud charges including:

  • Medical doctors
  • Physician assistants
  • Dentists
  • Chiropractors
  • Clinical psychologists
  • Optometrists
  • Nurse practitioners
  • Nurse midwife
  • Clinical social worker authorized to practice by the state