The Medicaid Fraud Control Unit is part of the New York State Attorney General’s office. It is charged with identifying, investigating, and prosecuting Medicaid fraud by physicians, nurses, dentists, pharmacists, physical therapists, durable medical equipment suppliers, hospitals, nursing homes, and other healthcare providers.
Medicaid fraud is the largest unit inside the Attorney General’s office, and it is staffed with some of the most experienced lawyers, auditors, and investigators. Every year, the unit recovers hundreds of millions of dollars from healthcare providers in the form of restitution and fines. It also receives 3 to 1 matching funds from the federal government. As a result of the money available, the unit is constantly adding more prosecutors, auditors, and investigators.
The Medicaid Fraud Control Unit is very aggressive. It does not focus only on so-called “Medicaid mills,” where organized criminals set up sham entities for the sole purpose of billing Medicaid. The unit also targets legitimate healthcare professionals.
In fact, the Medicaid Fraud Control Unit frequently targets physicians, pharmacists, and other healthcare professionals who run legitimate practices. Many of the unit’s prosecutions are for using the wrong billing codes, failing to maintain adequate records, or having business relationships that violate the anti-kickback and physician self-referral laws.
What may seem like a technical violation can result in felony charges and a prison sentence. Even if you avoid a criminal conviction, your career can be ended by the loss of professional licenses or exclusion from the Medicaid and Medicare programs.
Responding to a Medicaid Fraud Control Unit investigation requires highly specialized legal advice. It is not enough to retain a capable criminal defense lawyer. You need a lawyer who understands the constantly changing Medicaid rules, and who understands how the Medicaid Fraud Control Unit conducts investigations and makes decisions.
Early intervention is your best chance of avoiding a criminal prosecution or reducing the charges. If you are innocent, the investigation stage is your last chance to convince the investigators before criminal charges are filed against you. If you made mistakes, the investigation stage is your last chance to negotiate a financial settlement or favorable plea agreement.
Most Medicaid fraud cases are won (or lost) at the investigation stage, before the prosecutors have decided to file any criminal charges. By working with Medicaid Fraud Control Unit investigators early in the process, your lawyer can help you develop a strategy to respond to their concerns.
It is, therefore, critical to retain an experienced Medicaid fraud defense lawyer as soon as you have any indication that you are under investigation.
To schedule a free and confidential consultation with an experienced Medicaid fraud lawyer, call John Howley, Esq. at (212) 601-2728.
The criminal penalties for Medicaid fraud are severe. The penalties include restitution and fines, loss of professional licenses, and exclusion from the Medicaid program.
If you are convicted of a misdemeanor, you can be sentenced to up to one year in jail. If you are convicted of a felony, the most serious cases can result in a sentence of up to 25 years in prison. And if you are not a U.S. citizen, you may be deported.
What will happen in your case?
The answer depends on how you respond to the investigators, how strong the evidence is against you, whether you have been convicted of a crime in the past, and a number of other factors.
You need to sit down with an experienced Medicaid fraud defense lawyer immediately to assess your case and develop a strategy.
Medicaid fraud cases generally fall into two categories. Some cases can be defended. The evidence may be weak or ambiguous, and you may have legitimate explanations for what happened.
If the evidence against you is weak and you have strong defenses, your lawyer should make every effort to challenge the government. With thorough preparation, and by engaging with investigators early in the process, your lawyer may be able to convince them to drop the case completely or to resolve it with a monetary settlement.
In other cases, the evidence against you may be strong and you may have no real defense. Even in those cases, an experienced Medicaid fraud lawyer can take action to minimize or reduce the criminal charges. Some cases that begin with felony charges and the possibility of a prison sentence can be resolved with a misdemeanor plea and no jail time. In some cases, we have been able to negotiate plea agreements that avoid criminal charges and a criminal record altogether.
The key is getting an experienced Medicaid fraud lawyer involved at the earliest possible moment. Medicaid fraud prosecutions are like a cancer. Early intervention is critical to a successful outcome.
To schedule a free and confidential consultation with an experienced Medicaid fraud defense lawyer, call John Howley, Esq. at (212) 601-2728.
The Bureau of Fraud Investigation is part of the NYC Human Resources Administration. It is responsible for investigating Medicaid fraud. It has two primary offices at 151 West Broadway and 250 Church Street in Manhattan.
The bureau is staffed with experienced Medicaid fraud investigators. Many of the investigators have degrees in criminal justice, accounting, and related fields. They are trained in investigative techniques, including how to interrogate fraud suspects. They conduct more than 5,000 investigations every year.
You will first learn about the Bureau of Fraud Investigation when you receive a “target letter.” This letter asks you to come in for an “interview” with the investigators. It asks you to bring financial documents, such as tax returns and bank statements, to the “interview.”
The letter is called a “target letter” because it means that you are the target of a Medicaid fraud investigation. The investigators already believe that you have committed fraud. They are not asking for an interview so they can help you. They have built a case against you, and now they want to confront you with their findings.
If you go to the interview alone, they will try to get you to admit that you are guilty of Medicaid fraud. If you refuse, they will cross-examine you with all of the information they have gathered over the past weeks and months.
Long before you ever heard of the Bureau of Fraud Investigation, the investigators were busy building a case against you. They already have your Medicaid applications and re-certifications. They have payroll records from your current and former employers, some of your banking information, credit reports, car registrations and driver’s license, and deeds and mortgage documents if you own any real estate. They also have payroll records and other financial documents for everyone who lives with you.
Before the “interview,” the investigators already conducted site visits to your home. They may have taken pictures of your home, looked inside your windows, and interviewed your neighbors.
If the investigators determine that you committed Medicaid fraud, they will decide what to do next. The most serious cases will be referred to the District Attorney for criminal prosecution that can result in a criminal record, heavy fines, and even a prison sentence. Other cases will be referred to the City’s lawyers, who will sue you for tens of thousands of dollars. Some cases will be settled either by convincing the investigators that you did nothing wrong, or by agreeing to pay back some of the benefits you received.
What will happen in your case? That depends on how you respond to the investigators.
An experienced Medicaid fraud lawyer can help by reviewing your financial documents before anyone talks to the investigators. Your lawyer can identify problems and help you develop a strategy designed to (a) avoid criminal charges, (b) reduce any demands that you pay back benefits, and (c) eliminate any claims for penalties or interest.
To schedule a free and confidential consultation with an experienced Medicaid fraud lawyer, call The Howley Law Firm today at (212) 601-2728.
When clients receive a letter from the Bureau of Fraud Investigation, one of the first questions they ask is: Why did the investigators decide to investigate me?
You are being investigated because the information you provided on your application does not match up with what the investigators see in other records. Sometimes the other records suggest that you earn more money than you disclosed. Other times, the problem is confusion over where you live or who lives with you.
Some of the most common triggers for a Medicaid application fraud investigation are:
By the time you receive a letter from Medicaid fraud investigators, they have already completed most of their investigation. They have reviewed all of your applications and re-certifications for Medicaid benefits. They have compared the information you provided with property records, credit reports, car registration records, school records, and anything else that discloses where you live, where you work, and what you own. They have obtained your payroll records from your current and former employers.
The Bureau of Fraud Investigation letter asks you to come in for an “interview” with fraud investigators. The “interview” is actually an interrogation. Two investigators will put you in a small room with no windows. One will ask you questions and about every aspect of your family and financial life. The other investigator will write down everything you say that helps them build a case against you.
If the investigators believe that you committed a crime, then they will refer your case to the District Attorney for criminal charges. You could face grand larceny and other felony charges that carry a possible sentence of up to five years in prison.
Or the investigators may refer your case to the City’s lawyers, who may sue you for tens of thousands of dollars in benefits, plus interest and court costs.
In either event, anything you say to the investigators may be used against you in a court of law.
You need to get an experienced Medicaid fraud defense lawyer on your side. Your lawyer will review your documents before anything is said or turned over to the investigators. Your lawyer will meet with the investigators, discuss the issues, and in many cases negotiate a resolution that avoids any criminal charges or expensive lawsuits.
In most cases, you can avoid the interview and interrogation by having your lawyer talk to the investigators instead. If the investigators want you to pay back benefits, an experienced lawyer can often negotiate a reduction of their demand, the elimination of any penalties or interest, and a manageable payment plan with monthly installments.
To schedule a free and confidential consultation with an experienced Medicaid fraud defense lawyer, call The Howley Law Firm at (212) 601-2728 today.
The NYC Bureau of Fraud Investigation is responsible for investigating individual Medicaid recipients and their families. The most common problem they investigate is false or incomplete information on Medicaid application and re-certification forms.
When you applied for Medicaid, you signed an application form under penalty of perjury. By signing that Medicaid application form, you agreed to tell the truth and to inform Medicaid of any changes in your income or residence.
Most people who receive letters from the Bureau of Fraud Investigation were not 100% honest on their Medicaid application form. Many reported lower income than they actually earned. Some reported income from one pay stub or one job, but failed to report income from other sources such as commissions, bonuses, a side job, or rent payments.
Other targets of the Bureau of Fraud Investigation were not truthful about their living situation. Some provided an address in New York City on their application form, when they were actually living someplace else. Others said that they were separated from their partner or spouse, when they were actually living together.
Many other Medicaid fraud cases start because the recipient got a raise or a new job and failed to disclose their new income on a Medicaid re-certification form.
The worst thing you can do in this situation is lie to the investigators. They already have your payroll records from your current and former employers. They already have every address you ever put down on a driver’s license, car registration, other government document, or payroll record. If you claim that you and your partner or spouse are separated, they have your partner or spouse's address too. They have also sat outside your residence watching to see who comes in and out, and who stays for the night.
If the investigators believe that you committed fraud, they will send your case to the District Attorney for criminal prosecution. You may face grand larceny and other felony charges that could result in up to five years in prison if you are convicted.
Do not try to handle a Medicaid fraud investigation on your own. If you go to the “interview” alone, you will be placed in a small conference room with two investigators and no windows. They will interrogate you. They will take down everything you say. And they will investigate everything you say. Anything you say to the investigators can and will be used against you.
It does not have to happen this way. An experienced Medicaid fraud lawyer can often negotiate a settlement with the investigators that avoids any criminal charges – even if you made mistakes or were not 100% honest on your Medicaid application. In many cases, your lawyer can meet with the investigators for you, so you will not have to answer any questions that might incriminate you.
Do not face the investigators alone. Call The Howley Law Firm at (212) 601-2728 to schedule a free and confidential consultation with an experienced Medicaid fraud defense lawyer today.
Did you receive a letter from the Bureau of Fraud Investigation? Did they ask you to come in for an “interview”?
You are not alone. The Bureau of Fraud Investigation sends out more than 5,000 of these target letters every year. In some cases, it is just a mistake. In other cases, it is a serious matter that can result in criminal charges and even a prison sentence.
What will happen in your case? That depends on how you respond to the letter.
You have received this letter because the Bureau of Fraud Investigation believes that you lied on your application or recertification for benefits. Some of the common problems are: (1) not disclosing all of your income; (2) claiming that you and your partner or spouse are separated when you still live together; (3) not disclosing a change in your income; (4) having living expenses that are higher than your reported income; (5) not disclosing financial assistance from family members or other sources; and (6) continuing to receive Medicaid benefits from NYC after you moved outside the City.
The letter usually asks for tax returns, bank statements, and identification to prove where you live.
What happens next is extremely important. Whatever you do, do NOT ignore this letter. You need to respond. And the best response is based on careful preparation with an experienced Medicaid fraud defense lawyer.
Do not try to handle the investigators on your own. They handle thousands of these investigations every year. If you self-incriminate yourself, they may charge you with serious crimes that can result in heavy fines, a criminal record, and even a prison sentence.
Get an experienced Medicaid fraud lawyer on your side. To schedule a free and confidential consultation, call The Howley Law Firm at (212) 601-2728.
The Medicaid Fraud Control Unit (MFCU) is part of the New York State Attorney General’s Office. It is responsible for investigating and prosecuting Medicaid fraud and abuse. It focuses primarily on physicians, pharmacists, hospitals, nursing homes, and other healthcare professionals and providers who submit claims to Medicaid.
The prosecutors and investigators in the MFCU are experienced professionals. Many of the investigators are former NYPD detectives, with more than 20 years of experience and street smarts. The lead prosecutors have experience prosecuting complex financial frauds involving millions of dollars. They work with auditors and analysts from a number of state and federal agencies, including the Office of Medicaid Inspector General (OMIG), the Office of Inspector General (OIG) at the Department of Health and Human Services (HHS), and the Centers for Medicare & Medicaid Services (CMS).
By the time MFCU investigators contact you, they have already completed most of their investigation. They have gathered and analyzed all of your billing records, interviewed and obtained statements from former employees and patients, and concluded that you did something illegal.
The MFCU prosecutors and investigators have only one objective when they contact you: They want to gather additional evidence so they can charge you with serious crimes.
If you agree to talk to MFCU investigators alone, you will find yourself in a room with at least 3-4 people. They will have at least two investigators, at least one prosecutor, and often an auditor who has reviewed all of your billing records. You will be interrogated on details about specific patients and Medicaid claims that you may not have thought about for several years. Any inconsistency between what you say and what they have seen in the records – even innocent mistakes – will be used as evidence that you are a liar.
You should never meet with MFCU investigators alone. You should retain an experienced Medicaid fraud defense attorney who can talk to the investigators and prosecutors before anyone talks to you. A lawyer who has MFCU experience can often learn why the investigators are targeting you, what evidence they already have, and some of the weaknesses in their case. This information is critical to building an aggressive defense.
To schedule a consultation with an experienced Medicaid fraud defense lawyer, call The Howley Law Firm today at (212) 601-2728.
Several times every month, a mother comes into my office with the same problem. The NYC Bureau of Fraud Investigation claims that she committed Medicaid fraud because she did not report income earned by the father of her children.
Many of the women are telling the truth. They really are separated from the father of their children. They may or may not be getting any financial support. They desperately need Medicaid.
Some of the women are not telling the truth. They claim to be separated, but they are not.
Both groups of women can avoid serious consequences if they follow one simple rule: Never lie to the Medicaid fraud investigators.
You do not have to incriminate yourself. You have the right to remain silent. You also have the right to be represented by a lawyer. And if you handle the investigation properly, you can usually avoid serious consequences.
But if you lie to the investigators, they will show no mercy.
The medicaid fraud investigators already know where everyone lives, works, and gets their mail. They have obtained copies of each parent's driver's license, car registration, and pay stubs showing the addresses they use for their cars and paychecks. The investigators may have addresses from your credit reports, bank statements or credit card statements. They have sat outside your home watching, talking to neighbors, and taking pictures.
In one recent case, a woman went to see the investigator on her own. She told the investigator that her husband lived alone in Pennsylvania, and that she lived in Brooklyn with the children.
The investigator, however, had the husband's cell phone and EZ-Pass records, which showed that his cell phone and car never left the five boros of New York City.
By the time the woman came to see me, she and her husband had been arrested, fingerprinted, and charged with serious felonies. They ended up pleading guilty to misdemeanors, paying a fine, but thankfully avoiding prison.
In another recent case, a couple admitted to me that they falsely stated that they were separated on their Medicaid application and recertifications. I went to see the investigator, alone, and negotiated a settlement before any criminal charges were filed. My clients never had to face questioning by the investigators. I even negotiated a payment plan, so they could pay back benefits over time with no penalties and no interest.
The lesson is simple. Do not lie to Medicaid fraud investigators. In fact, do not talk to investigators alone. Get an experienced Medicaid fraud defense attorney on your side.
To schedule a free and confidential consultation with an experienced Medicaid fraud lawyer, call The Howley Law Firm today at (212) 601-2728.
Medicaid fraud investigations are like a cancer. Early detection and response by an experienced professional can greatly increase your chances of survival.
The Medicaid fraud investigators will decide whether or not to refer your case for criminal prosecution. The consequences of that decision are serious. A criminal prosecution may result in heavy fines, a criminal record, a prison sentence, loss of professional licenses and, if you are not a U.S. citizen, deportation.
You do not want the investigators to make that decision without first considering the evidence in your favor.
The first step is to retain an experienced Medicaid fraud lawyer who is intimately familiar with these types of investigations. By discussing your case with the investigators early in the process, your lawyer can find out what is bothering them, how strong their case is, and where the weaknesses in their case are.
In some cases, your lawyer may be able to provide information that helps the investigators decide not to charge you with a crime. In every case, getting information from the investigators early in the process helps you develop your defenses.
Investigators have the most flexibility early in the process, before a final decision is made. They may decide to drop the investigation based on evidence you provide through your lawyer. Or they may agree to settle the case by having you pay back money. Or they may enter into a cooperation agreement with you if you have evidence against other people they are investigating. Or they may decide to charge only minor crimes, instead of major felonies.
Many of these options disappear, however, once the investigators refer your case for criminal prosecution. At that point, the prosecutor will usually insist on some form of guilty plea and much higher financial penalties.
Simply put, acting quickly to address a Medicaid fraud investigation is your best, and possibly your last, chance of avoiding a criminal record.
To schedule a free and confidential consultation with an experienced Medicaid fraud attorney, call The Howley Law Firm today at (212) 601-2728.
Every week, Medicaid recipients receive letters from the Bureau of Fraud Investigation at the NYC Human Resources Administration. The letters ask you to come in for an "interview" with a Medicaid fraud investigator. They also ask you to bring your tax returns and other documents.
Most people think the investigator wants your tax returns to verify your income. That is not the primary reason. The fact is, the investigator already has your income records. Long before you received that letter, the investigator asked your current and former employers for your payroll records. The investigator already knows how much you were paid.
The investigator wants your tax returns to get other information that will help them prove you committed fraud. Here is some of the information the investigator wants to see on your tax returns:
Your Address: New York City has the most generous Medicaid program, much more generous than New Jersey, Long Island, or Westchester. But only New York City residents are eligible for NYC Medicaid benefits. If you used a New York City address to obtain Medicaid benefits, but the address on your tax returns is outside the City, you could face serious criminal charges for fraud. You need to call an experienced Medicaid fraud attorney before you meet with the investigator or turn over any documents.
Your Marital Status: If you claimed that you were single or separated on your Medicaid application, but your tax returns were filed jointly with your spouse, you have a serious problem. Better call an experienced Medicaid fraud attorney before you see the investigator or turn over any documents.
Your Deductions: If you own a home, you probably deduct the mortgage interest you paid last year on your tax returns. There is nothing wrong with that. In fact, you may own a home and receive Medicaid if your income is low enough to qualify for benefits. The problem is when your mortgage interest deduction is suspiciously high. For example, if you claimed on your Medicaid application that you earned less than $25,000 per year, but your tax returns show that you claimed $15,000 in mortgage interest payments, the investigator will suspect that you had another source of income or financial support.
Unreported Income and Financial Support: Most people think they cannot be accused of fraud if they submitted their recent pay stubs when they applied for Medicaid. This is not true. You are required to disclose all income and financial support on your Medicaid application - including income that may not appear on your pay stubs. This is a very complicated issue. For example, if you took a lump sum payment from your IRA or 401-k, that is not considered income for purposes of Medicaid. But if you took the same amount of money from your IRA or 401-k in monthly installments, that may be considered income. Do not guess. Get advice from an expert.
These are just a few of the issues that can get you into serious trouble in a Medicaid fraud investigation. Before you meet with the investigator or turn over any documents, click here to download a free copy of our Special Report, "5 Deadly Mistakes in Medicaid Fraud Investigations."
To arrange a confidential consultation with an experienced Medicaid fraud attorney, call The Howley Law Firm today at (212) 601-2728.
Medicaid fraud cases are often won (or lost) at the investigation stage, Before you talk to investigators, educate yourself by downloading a free copy of our special report.