What Happens If I’m Caught Lying to Medicaid?

Many people lie in order to gain something. In certain situations, it is important to determine if the gain is worth more than what you could potentially lose. More American citizens are taking advantage of government health care programs like Medicaid every single day and since most people do not get caught in the act at first, others looking to bilk the program of hard earned tax dollars are encouraged to commit fraud.

What Happens When You Lie to Medicaid

Lying to Medicaid Is a Serious Crime

Some people lie intentionally while many others have no intention to lie and simply make a mistake. There is a significant difference between purposely falsifying information in order to receive Medicaid and food stamps, and accidentally not reporting when circumstances change, Regardless, it is wrongful and against the law to present untruths on a Medicaid application, and every applicant should present their information accurately. Though the potential consequences of fraud are often overlooked, it is crucial that any person even considering the notion understands that falsehoods on a Medicaid application are a felony, and the person may face very serious consequences including massive fines and even jail time.

What Happens If You Are Caught Lying on Your Application?

When you are caught lying to Medicaid, you will receive a letter in the mail from the Human Resources Administration (HRA) asking you to come to a specific location for an “interview,” along with your tax returns and other financial or personal records related to your Medicaid eligibility, or lack thereof. It is imperative to respond to this letter immediately; if you choose to wait it out and ignore the letter, your case will be sent to the District Attorney and your investigation will likely become a criminal investigation. While the term “interview” may seem fairly innocuous, in reality, the investigation has already been going on and at this point, investigators are trying to find additional evidence to finalize the case against you.  What many people unfortunately don’t know is that you absolutely have the right to consult with and bring a licensed Medicaid fraud attorney with you to the interview, and it is highly recommended that you do so. Handling the case yourself, unless you are knowledgeable of Medicaid and the laws surrounding the program, will most likely result in you being found guilty.

If you decide to bring an attorney to represent you, the chances of you being vindicated or negotiating a settlement are infinitely higher. However, if you decide to handle the interview yourself and end up being found guilty, bring the letter a qualified Medicaid fraud lawyer, go over your situation with them, identify any issues, and develop a strategy in order to avoid severe criminal charges. Consequences for lying on a Medicaid application can be as serious as facing hefty fines to repay the money spent on health care services or face criminal prosecution and spend up to five years in prison. Most often, experienced Medicaid fraud attorneys may negotiate a financial settlement that is usually less than the money received as benefits, and will ultimately avoid criminal charges on your behalf. However, before you consider lying about your information on a Medicaid application, ask yourself if it is a risk truly worth taking.

12 Replies to “What Happens If I’m Caught Lying to Medicaid?”

  1. If someone gets medicad when single then gets married and doesn’t tell that they are married and they still keep getting it with out reporting it will they get in trouble

    1. I’m 22 and pregnant. Im on my parents insurance but applied for medicaid and didn’t put that i had insurance through them, on accident. I updated it as soon as i spoke with my mom. I have not used it for any thing as of right now. But im freaking out cause it was an honest mistake.

  2. Have just discovered family member lied to Medicaid and received 7 years of nursing home care while serving as a power of attorney. Not quite understanding why state did not check the assets. There were over 300.000.00 excluding house. Knew nothing about this until the death.

  3. Is it considered fraud if someone uses your child’s information for Medicaid in a state that the child does not live in

  4. An ex family member told her lawyer that she is now on Medicaid because my current family member was not providing insurance as required by the divorce decree. His company downsized so We went through the marketplace and he was denied Medicaid due to his and his ex’s income being too high so he bought a policy instead. She was impatient and jumped the gun so now the kids are covered by insurance and Medicaid. The problem is, she would have had to spin several lies in order to get the kids to qualify. How should we go about reporting the fraud?

    1. I can’t advise you how to lie to Medicaid but if honest mistake was made you can call and get kids off Medicaid. Kids are always eligible for Health Plus insurance as long as you disclose correct income. If you want more specific advise please call 718-333-2395 and we can discuss

  5. So we got Medicaid for our twins when they were born 2019. My husband Gets paid 17.5 per hour and I’m a staying home mom (we have our health insurance through marketplace) He just found out that we supposed to report any income change. Well the thing is that this year he got paid more, but on bonus, but he really doesn’t know when he is getting those bonus (it all depends how the company does that month) so this year he actually made more than the maximum income needed for a family of 4 for Medicaid and well…. now that he is reapplying for the health Insurance we just find out that he suppose to tell about this income change (but his actual hourly paid is still the same) and we are just worried about how much Medicaid can charge us for this mistake. What can really happen? Does anyone know or had being trough this situation? It’s so scary, because today Friday he had being trying to call them. And after waiting and waiting on the line, the call just gets cancelled, so we hope to go in person on Monday.

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