Medicaid Fraud Attorney serving NYC Clients

Facing a Medicaid Fraud investigation in New York City can be one of the most terrifying experiences of your life. A single accusation can threaten everything you’ve worked for your professional license, your financial security, and even your freedom. The stakes are incredibly high: you could face crippling fines, civil judgments, prison time, and, if you are not a U.S. citizen, possible deportation. These investigations are emotionally overwhelming, and without the right legal representation, they can spiral out of control. That is why having an experienced Medicaid Fraud attorney by your side from the very start is critical to protecting your future.

If you are facing a Medicaid Fraud investigation in NYC, an FBI officer has rung your bell, or you received a letter from the Office of Medicaid Inspector General (OMIG), don’t panic. Medicaid Fraud Attorney has twenty-seven years of experience successfully handling Medicaid fraud cases for both providers and recipients. When working with our firm, you will work directly with our principal attorney, Inna Fershteyn, and your case will be based on a well-thought-out strategy and plan.

Medicaid Fraud Attorney Inna Fershteyn

#1 on Yelp’s list of best Medicaid Fraud Attorneys in NYC

How We Defend Medicaid Fraud Cases in NYC

Every Medicaid Fraud case is unique and requires a tailored defense strategy. We do not rely on simplistic approaches. Instead, we build a comprehensive customized plan designed around the facts of your case, your background, and your goals. Our process includes:

  1. Comprehensive Case Assessment and Strategy Development
    We begin by conducting a detailed review of your case, including the HRA or OMIG allegations, your financial records, and prior submissions. We collaborate with billing and coding specialists and compliance consultants to uncover errors, inconsistencies, or mitigating factors that can weaken the government’s case. This allows us to craft a defense strategy tailored specifically to you.
  2. Challenging the Evidence and Proving Lack of Intent
    Most Medicaid Fraud allegations hinge on whether you knowingly provided false information or committed intentional wrongdoing. We aggressively challenge the evidence by highlighting documentation errors, system glitches, or misunderstandings that may have triggered the investigation. Our goal is to show there was no fraudulent intent.
  3. Strategic Negotiation for Reduced Penalties
    If prosecutors or agencies pursue action, we advocate on your behalf to achieve the most favorable outcome possible. We negotiate directly with the HRA, OMIG, or District Attorney’s office to reduce penalties, avoid criminal charges, and resolve matters through administrative settlements whenever possible.
  4. Protecting Your Career, Licenses, and Future
    For healthcare providers, professional licenses are at risk. We work to prevent suspensions, disqualifications, or Medicaid provider exclusions that can end your career. Our priority is safeguarding your livelihood while minimizing financial and criminal exposure.

Get prompt, reliable legal assistance when you call now.

  • Over 270 top ratings from our local clients – no other firm has our accolades 
  • Immediate expert help from our Medicaid Fraud attorney 
  • 27 years of daily experience dealing with Medicaid Fraud case investigations and HRA fraud letters  
  • Experience with Brooklyn DA office, Queens DA office, Staten Island DA office, Bronx DA office, Manhattan DA office, Nassau County DA office, Office of Medicaid Inspector General (OMIG), and State of NY Office of Attorney General

Our Attorney’s Experience with Medicaid Fraud

Attorney Inna Fershteyn has over 27 years of experience defending clients against Medicaid Fraud allegations throughout New York City. She is admitted to practice in New York State and New Jersey,  and is a member of the New York State Bar Association.

Attorney Inna Fershteyn is one of the most experienced Medicaid Fraud attorneys in New York. She has recently closed high profile cases with the U.S. Attorney’s Office, the Bronx DA, and the Nassau and Brooklyn DA offices, defending clients accused of fee sharing, Medicaid and HRA fraud, and failing to report income, assets, or changes in household structure. As a New York State certified mediator with over 600 resolved disputes, she is highly skilled at negotiating settlements and achieving favorable outcomes. Ms. Fershteyn has consistently secured victories before the Office of the Medicaid Inspector General (OMIG), the Office of Professional Medical Conduct (OPMC), and multiple District Attorney offices across NYC.

Her defense strategies are grounded in the latest federal and state enforcement trends, drawing on guidelines from the Office of the Medicaid Inspector General (OMIG), Department of Justice (DOJ) enforcement priorities, and New York State Attorney General’s Medicaid Fraud Control Unit (MFCU) press releases. She uses this deep knowledge to anticipate how investigators build cases and how to dismantle them before they reach the courtroom.

Proven Results for Our Clients

Our firm has successfully defended hundreds of Medicaid recipients and healthcare providers in complex fraud investigations. Here are just a few examples of how we’ve protected our clients’ futures:

  • Case 1 – Provider Avoids License Revocation: A Queens based home health agency owner was accused of billing for services not rendered. By working with independent billing and coding experts, we demonstrated that the discrepancies were clerical errors, not fraud. The case was resolved through an administrative settlement with no criminal charges and the client retained their license.
  • Case 2 – Recipient Avoids Criminal Prosecution: A Brooklyn single mother was investigated by the HRA for failing to disclose her partner’s income. We gathered documentation showing she had attempted to report the change and that the agency failed to process it. The case was closed without referral to the District Attorney’s office, and she kept her Medicaid coverage.
  • Case 3 – Reduced Penalties Through Negotiation: A Staten Island physician faced allegations of overutilizing services and issuing unnecessary referrals. We presented expert medical opinions refuting the allegations and negotiated a reduced restitution amount, avoiding license suspension and criminal charges.

These results are not guarantees, but they reflect our commitment to building customized defense strategies that protect our clients’ careers, reputations, and futures.

HRA Fraud Case Closed by Top NYC Medicaid Fraud Attorney Inna Fershteyn - YouTube

medicaid-fraud-attorney

What is Medicaid Fraud?

Medicaid fraud refers to any intentional act of deception or misrepresentation by an individual who is receiving Medicaid benefits. This can include lying about income, assets, or other eligibility requirements in order to obtain benefits or receiving Medicaid benefits while also receiving benefits from another source, such as workers' compensation or private insurance. Medicaid fraud is a serious offense and can result in legal and financial penalties, including fines, imprisonment, and loss of Medicaid benefits.

What is Medicaid Fraud for Providers?

Medicaid fraud for providers constitutes billing for services not provided, performing unnecessary tests, providing patients with unnecessary referrals, and charging separately for services usually offered at a packaged rate.

What is Medicaid Fraud by the Recipient?

Medicaid fraud by the recipient is mainly due to not disclosing correct income, providing incorrect information about your residential address, and receiving Medicaid benefits illegally. If you received a letter from NYC HRA stating that your eligibility for Medicaid health insurance is under review, you are being investigated for Medicaid fraud.

The NY Food Stamp HRA Investigation sent me a letter regarding my SNAP Benefits, what should I do?

If you have recently received a letter regarding your SNAP Benefits from the NY Food Stamp HRA investigation, the letter should have come from 375 Pearl Street, 22nd floor, New York, NY. This letter will contain a request for you to come in so you can prove that the details you provided on your SNAP benefits application are correct. This will include your address, income, and will verify that you didn’t make any cash bank deposits. 

You will also be required to verify that you don’t own any properties aside from personal residence and that you listed ALL the members of your household on your application including a significant other – even if you are not legally married and if they are not the parents of your kids. 

Failure to respond to such a notice like the HRA Medicaid fraud investigation letter will cause your case to be sent to the District Attorney’s office for further investigation. This can lead to both: charges and possible arrest. 

It is important to never go to the HRA SNAP benefits investigation office without your attorney in attendance at the meeting since everything that you say will be used in the case against you.

I received a letter from HRA Medicaid Fraud Investigations, Bureau of Fraud Investigations (BFI), what should I do?

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 the investigator against you. When investigators call you in for an interview, they already assume that you have committed Medicaid Fraud. Seek the help of an experienced HRA Fraud Investigation Attorney who will represent you in your Medicaid Fraud investigation case. 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 in NYC?

Whether you are in Manhattan or any of the 5 Boroughs, 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 the 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.

Medicaid Fraud Penalties in New York

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.

owning-a-new-or-expensive-car7 Common Medicaid Fraud Schemes by Healthcare Providers

Whether it's accidental or intentional, it is easy for healthcare providers to engage in common healthcare fraud schemes. Below are some common Medicaid fraud schemes.

1. BILLING FOR NON-RENDERED SERVICES
In many cases, healthcare providers, bill for services that were never provided and the corresponding patient files have no evidence or information regarding  such documented services. Healthcare providers often provide excuses, but these excuses do not help their case.

2. INCORRECT RECORDING OF PROCEDURES
In this healthcare scheme, healthcare providers list an incorrect diagnosis or procedure that was performed on a patient. This may include admitting patients for unnecessary hospitalizations.

3. UNNECESSARY ISSUANCE OF PRESCRIPTION DRUGS
Patients are sometimes given prescribed medication for reasons beyond the physician's intentions. Similarly, some physicians issue prescription drugs for patients for their personal gain.

4. OVERUTILIZATION OF SERVICES
This typically involves billing for services that are not necessary to perform at all. This may include unnecessary blood tests or physical examinations that the patient receives despite having overall good health.

5. MISREPRESENTING DATES OF SERVICE
Healthcare providers may try to make more money by documenting the same patient on two different days. This may happen since each office visit to the physician is considered a separate billable service.

6. CORRUPTION
Providers have been known to receive money for referrals. Consequently, many physicians have abused this power through referring patients to unnecessary services such as MRIs or X-rays.

7. KICKBACKS

While it might be common to gift someone money for referrals in other areas of business, it is illegal for healthcare providers to do so. Both, the provider who gifts money and the provider who refers for money are in the wrong.

Always work with a qualified NYC medicaid fraud attorney. Our law firm can help you to avoid such harsh consequences and minimize the restitutions payments.

2025 Medicaid Fraud Enforcement Trends in New York

Medicaid Fraud enforcement in 2025 is stricter than ever, and agencies are using increasingly aggressive tactics to pursue both providers and recipients. The Office of the Medicaid Inspector General (OMIG), the U.S. Department of Justice (DOJ), and the New York State Attorney General’s Medicaid Fraud Control Unit (MFCU) have all announced expanded crackdowns on fraud, waste, and abuse.

Investigators are now relying heavily on advanced data analytics and cross agency data sharing to detect even minor discrepancies in billing, income reporting, or household information. This means cases are being flagged faster, investigated more deeply, and referred for prosecution more often than in past years.

Because of these new enforcement priorities, even small mistakes are being treated as potential fraud. If you receive a letter from the HRA or OMIG or suspect you may be under investigation you must act immediately. Delaying or trying to handle it on your own can lead to license loss, massive financial penalties, or even criminal charges. Contact an experienced Medicaid Fraud attorney as soon as possible to protect yourself.

4-senior-scams-and-how-to-avoid-them

Frequently Asked Questions About Medicaid Fraud in NYC

What happens if I ignore an HRA Medicaid fraud letter?
Ignoring an HRA Medicaid fraud letter will almost always make your situation worse. If you do not respond, your case may be referred to the District Attorney’s office for criminal investigation and possible prosecution. It is critical to contact an experienced Medicaid Fraud attorney immediately to intervene before your case escalates.

Can Medicaid fraud cases be settled out of court in NYC?
Yes. Many Medicaid fraud cases can be resolved through administrative settlements without going to court or facing criminal charges. Our firm often negotiates directly with the HRA, OMIG, or District Attorney’s office to reduce penalties, arrange repayment plans, or close cases before they become criminal matters.

Will I lose my professional license?
It depends on the allegations and the outcome of your case. Healthcare providers found guilty of Medicaid fraud can face suspension or revocation of their licenses. However, with strong legal representation, it is often possible to avoid disciplinary action or negotiate for lesser administrative penalties to protect your professional future.

Does the FBI investigate Medicaid fraud?
Yes. In serious or large scale cases, the FBI and federal prosecutors can become involved, especially if the alleged fraud involves multiple states, high dollar amounts, or organized billing schemes. Even if your case starts at the local level, it can be escalated to federal authorities which is why early legal intervention is crucial.

Can I go to jail for Medicaid fraud in New York?
Yes. Medicaid fraud is a criminal offense in New York, and convictions can carry penalties including fines, restitution, and prison time. However, many cases can be resolved without criminal charges if an experienced attorney gets involved early and presents a strong defense strategy.

Medicaid Fraud accusations do not simply disappear, they grow more serious the longer they are left unaddressed. Investigators are trained to build a case against you, and walking into an interview alone can result in devastating admissions that will be used to prosecute you. The consequences can be life altering: losing your license, your livelihood, and your freedom. With the right attorney, you can fight back, protect your reputation, and minimize or even avoid penalties. Do not gamble with your future. Contact our office today at (718) 333-1233 to safeguard your career, your finances, and your family from the life shattering consequences of a Medicaid Fraud investigation.

We want to help you address your Medicaid Fraud legal needs
(718) 333-1233
1517 Voorhies Ave Suite 402
Brooklyn, NY 11235