FREQUENTLY ASKED Medicaid Fraud Investigation Questions, NY Top medicaid Fraud attorney explains it

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

What is Medicaid fraud and why am I being investigated?

In simple terms, Medicaid fraud is the misuse of federal Medicaid funds and benefits. It can be committed by both  providers and beneficiaries.

What are the penalties for Medicaid fraud?

The penalties for Medicaid Fraud are criminal or civil prosecution. A conviction can result in a heavy fine or even jail time.

Can my place of work find out that I am being investigated by the HRA?

In most cases, your place of work would not be notified of a Medicaid fraud investigation unless there is a specific reason to do so, such as if your place of work is a healthcare provider or is also being investigated for fraudulent billing practices. However, it is important to note that if you are found guilty of Medicaid fraud, this could have negative consequences for your employment, especially if you work in a field that requires a professional license or has a code of ethics that prohibits fraudulent behavior. Medicaid fraud is considered a serious offense

Do you need to report to Medicaid that you moved to a different state?

Yes, if you are enrolled in Medicaid and you move to a different state, you are generally required to report your change of address to your local Medicaid office. This is because Medicaid is a state-administered program, and each state has its own rules and eligibility requirements. Failing to report your change of address to Medicaid could result in the termination of your Medicaid coverage or other penalties.

How often should I inform Medicaid of any changes to my income, marital status or housing?

Any changes to your income, marital status or housing should immediately be reported to Medicaid, as this can drastically change your coverage. If you don’t report these changes right away, you may be charged with Medicaid Fraud if you wrongfully received benefits that you no longer qualify for.

If I don’t complete the Medicaid Recertification, am I still held liable for changes to my income?

Yes, you are held liable for completing Medicaid Recertification. If you don’t, information provided in previous years will be used and it will be assumed that no information has changed.

Should I inform Medicaid that I no longer live with my spouse?

If you are enrolled in Medicaid and no longer living with your spouse, you may be required to inform your local Medicaid office about this change in your living situation. This is because Medicaid eligibility is based on a number of factors, including household income and size. If you are no longer living with your spouse, your household income and size may have changed, which could affect your eligibility for Medicaid. Depending on the rules of your state’s Medicaid program, you may need to provide proof of your new living arrangements, such as a lease agreement or utility bill in your name.

What is the NYC Human Resources Administration (HRA)?

The NYC Human Resources Administration is a department of the government of New York City dedicated to fighting poverty and income inequality by providing New Yorkers in need with essential benefits through numerous social service programs.

What is the Bureau of Fraud Investigations (BFI)?

The Bureau of Fraud Investigation (BFI) conducts investigations of individuals and organized groups who are suspected of committing Medicaid fraud. It is part of the NYC Human Resources Administration’s Office of Investigation.

BFI is located at 375 Pearl Street, 22nd Floor, NY, NY 10038 or at 243 Schermerhorn Street, 5th Floor, Brooklyn, NY 11201

What is the New York Medicaid Fraud Control Unit (MFCU) and how does it operate?

The New York Medicaid Fraud Control Unit (MFCU) is a law enforcement entity made up of investigators, auditors, attorneys, and administrative staff. It has the statewide authority to investigate, penalize, and prosecute individuals involved in criminal welfare cases in New York

What is an Administrative Disqualification Hearing?

If the BFI does not categorize your case as a criminal offense, the investigator may refer your case to the Office of Administrative Hearings (OATH) at the New York State Department of Social Services for an Administrative Disqualification Hearing. The purpose of this hearing is to attempt to ban you from receiving benefits for a specific period of time.

Why did I receive a letter from the BFI?

Providing false income information on Medicaid applications/recertifications, duplicating or sharing Medicaid ID cards, requesting unnecessary medication or medical procedures, and/or other irresponsible utilization of Medicaid services may have sparked suspicion surrounding your eligibility for Medicaid benefits and made you a target of investigation.

Can the HRA Medicaid Fraud office find out that I provided false information on my application?

The HRA has access to databases containing information about your employment, education, property, and banking records. In the event that the information you provided on your application/recertification does not match the information listed in the databases, you will be targeted for Medicaid fraud investigation.

What should I do if I receive a letter from the NYC HRA Bureau of Fraud investigation?

If you receive an HRA Fraud investigation letter, you should immediately hire an experienced Medicaid Fraud attorney who will represent you in your Medicaid Fraud investigation case. Such an attorney will meet with you, evaluate your case and the charges being brought against you and then gather relevant documents and go through the investigation process, which will no longer require your presence as you will be represented by your attorney. It will be necessary for you to sign a HIPPA release and letter of representation when you hire a Medicaid Fraud attorney to represent you in New York.

Who is investigating me for Medicaid fraud?

Medicaid fraud committed by participants is investigated by the Department of Social Services or the HRA office. The Attorney General’s Office and the Medicaid Fraud Control Units are the only establishments that have a right to investigate fraud committed by providers.

What are my rights if I am being investigated for Medicaid fraud?

During the Medicaid Fraud interview, you have the right to remain silent. In addition, the HRA letter states that you have the right to bring an attorney to the initial meeting with an investigator. Prior to this meeting, you can, and should, meet with a qualified Medicaid fraud attorney to discuss your rights in detail and submit any necessary documents for review.

Can I refuse to answer questions during my HRA fraud interview?

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.

What process does the HRA fraud department undertake to investigate me?

  1. The NYC HRA investigators begin an investigation because of inconsistencies in your bank or property records or tax returns, or a phone call from a Medicaid fraud whistleblower (a person who reports people that they suspect are guilty of committing Medicaid fraud).
  2. You will receive a request from the HRA to authorize the release of your information to the HRA Bureau of Fraud Investigation and related third parties. The investigators will have the opportunity to conduct field visits which consist of taking photos of your house, your cars, and your workplace.
  3. Once the field visits are completed, the investigators will send a letter requesting you to come in for an interview and submit various documentation so that they may analyze your eligibility for Medicaid.
  4. An experienced Medicaid fraud attorney will always want to review and analyze your Continuing Disability Reviews (CDRs). A CDR is a detailed form listing all payments made by the provider for the recipient in the Medicaid fraud case.
  5. Finally, you and your Medicaid fraud attorney will meet with the HRA investigator for your interview.  From here, you will review your document, discuss any settlement options, and/or give any evidence that may dismiss your case, or subject it to court prosecution.

Can I refuse to let a Medicaid fraud investigator into my home?

You may be allowed to refuse a Medicaid fraud investigator access into your home, but make sure to call your lawyer right away.

What are the possible outcomes of a edicaid fraud investigation?

If you are convicted of Medicaid fraud, the legal consequences may include monetary fines, restitution orders, disqualification from receiving Medicaid benefits, wage garnishment, criminal prosecutions, prison sentences, suspension or loss of professional licenses, asset confiscations, and/or deportation.

What is the New York Medicaid Fraud Control Unit (MFCU) and how does it operate?

The New York Medicaid Fraud Control Unit (MFCU) is a law enforcement entity made up of investigators, auditors, attorneys, and administrative staff. It has the statewide authority to investigate, penalize, and prosecute individuals involved in criminal welfare cases in New York.

What types of medical providers are targeted for fraud charges?

Medical providers and practitioners across a multitude of fields are targeted for fraud charges, including doctors, physician assistants, dentists, chiropractors, optometrists, clinical psychologists, nurses, and more.

Do I need a Medicaid fraud attorney if I receive an HRA or SNAP fraud investigation letter and how can an experienced attorney help me?

It is highly recommended that you hire an experienced Medicaid fraud attorney in order to avoid incriminating yourself and thereby undermining your case with any sensitive information you disclose. An experienced Medicaid investigation lawyer  will help you go through the investigation process as smoothly as possible while also safeguarding your interests. New York’s top Medicaid fraud attorney knows how to prevent disclosing any self-incriminating information, while also providing all the appropriate documents required by the investigators and reducing any charges against you.

If I am not eligible for Medicaid and my work cannot provide me with medical coverage, what other choices to get coverage do I have after closing a Medicaid fraud case?

If you are not eligible for Medicaid and your work does not provide you with medical coverage, your options for acquiring coverage include applying for Obamacare, the Medicaid Essential Plan or private insurance.

What can happen to me if I refuse to sign a settlement agreement with the Bureau of Fraud Investigation?

If you refuse to sign a settlement agreement your case can go to the District Attorney’s office (Manhattan or Brooklyn) and turn into a criminal investigation or be sent for civil litigation.

How can I find out how much money I owe to the HRA if I was not eligible for Medicaid?

If you do not know how much money you owe to the HRA, a Central Data Repository with the accumulated amount will be provided to you.

What is the statute of limitations for Medicaid fraud?

The statute of limitations for Medicaid Fraud is six years from the date of the last occurrence.

How much money can I make to avoid a Medicaid Fraud investigation?

You can make $825 a month per person to avoid a Medicaid Fraud investigation.

How long does a Medicaid fraud investigation last?

Medicaid fraud investigations usually last from 2 weeks to 3 months, but can go on indefinitely depending on the case.

If there is a claim against me, should I pay everything back in full or do I have the choice to pay monthly installments?

You have the choice to pay a lump sum or in monthly installments.

How many Medicaid fraud investigation offices are in New York?

There are two fraud investigation offices in New York, one located in Brooklyn at 243 Schermerhorn Street and the other in Manhattan at 375 Pearl Street on the 22nd floor.

Important Addresses:

SNAP Benefits Fraud Investigation Unit
375 Pearl Street, 22nd Floor NY NY 10038

Medicaid HRA Fraud Control Unit
375 Pearl Street, 22nd Floor  NY NY 10038

Medicaid HRA Fraud Investigation Unit
243 Schermerhorn St, 5th Floor   Brooklyn, NY 11201

Call us at (718) 333-1233 or contact us online to schedule a consultation with New York’s most experienced and trustworthy Medicaid Fraud attorney.