Medicaid Fraud Cases Can Result in Civil and Criminal Penalties
Medicaid fraud investigators have several options if they discover that you have provided inaccurate or incomplete information on your applications for Medicaid or Family Health Plus benefits.
The investigator may offer you a confidential settlement. The investigator may send your case for civil litigation – in other words, you may be sued for the amount of benefits you received. Or the investigator may refer your case to the local District Attorney for criminal prosecution.
Some of the most common types of criminal charges for Medicaid fraud are:
Making a False Written Statement: Knowingly making a false statement on your Medicaid or Family Health Plus application is a class A misdemeanor. You can be sentenced to spend up to one year in jail. (N.Y. Penal Law § 210.45).
Offering a False Instrument: Submitting an application or recertification that you know contains false information may be charged as a felony if the government can prove that you submitted the document with the intent to obtain benefits for which you did not qualify. This is a class E felony. You can be sentenced to spend up to four years in prison. (N.Y. Penal Law § 175.35).
Welfare Fraud: Lying on an application or recertification to obtain any form of public assistance benefits worth more than $3,000 is a class D felony. You can be sentenced to spend up to seven years in prison. (N.Y. Penal Law § 158.15).
Grand Larceny: Prosecutors often add a charge of grand larceny based on the value of the benefits you received. In Medicaid fraud cases, the charges are usually a class D felony if the benefits exceeded $3,000. That could result in you spending up to seven years in prison. If the benefits exceeded $50,000, then you could be charged with a class C felony. That could result in you spending up to 15 years in prison. (N.Y. Penal Law § 155.35(1)).
In addition to serving time in prison, you may be ordered to pay back all the benefits that you received. This could amount to tens of thousands of dollars. You also may be fined up to $1,000 per count for misdemeanors and up to $5,000 per count for felonies.
Why do some Medicaid fraud cases result in settlements, while other cases result in serious criminal charges? It all depends on how you respond to the investigation.
Anything you say to the investigator can and will be used against you. On the other hand, if you refuse to cooperate with the investigator, that may cause the investigator to send your case to criminal prosecution instead of a civil settlement. You need to develop a strategy based on your specific facts and circumstances.
Get an Expert on Your Side: If you receive a letter from the Bureau of Fraud Investigation, or if you are contacted directly by a Medicaid fraud investigator, then you should contact an experienced Medicaid fraud lawyer immediately to protect your rights. In many Medicaid fraud cases, contacting a lawyer can mean the difference between a confidential settlement or serious criminal charges.
For more information, click here to download our free report, "5 Deadly Mistakes in Medicaid Fraud Investigations."
Then call our law offices at (212) 601-2728 to schedule a consultation with an experienced Medicaid fraud defense attorney.
Non-Disclosure of Spouse's Income Prompts Investigation Into Eligibility for Family Health Plus Benefits
Your Spouse's Income Must be Disclosed Even if Not Living With You
Mrs. S. applied for Medicaid benefits at a time when her marriage to Mr. S. was not going well. She and her two children were living with her mother. She did not list her husband on the Medicaid application form. She also did not mention her husband's income.
Mrs. S. and her children were approved for Family Health Plus benefits.
Mr. and Mrs. S. never got divorced. They never had a formal separation agreement. They just lived apart for an extended period of time.
A few months after she was approved for Family Health Plus benefits, Mrs. S. and the children moved back into the family home with Mr. S. They stayed together as a family for the next three years, except for a six-month period when Mrs. S. brought her children to live with her mother again.
When the Family Health Plus renewal form came in the mail, Mrs. S. just signed the form and returned it without indicating that anything had changed. The renewal or re-certification forms, therefore, did not disclose her husband's income or that she was living with her husband. In her own mind, she justified this because she sincerely did not know how long they would stay together.
Then she received a letter from the Bureau of Fraud Investigation. The investigator asked her to bring tax returns, bank statements, her marriage certificate, and the children's birth certificates to an "interview." Obviously, the investigator knew that Mrs. S. was married.
What Mrs. S. did not know is that the investigator also had photos of Mr. and Mrs. S. entering and leaving the family home together. He also had payroll records from the husband's employer.
Luckily, Mrs. S. consulted with a Medicaid fraud lawyer before saying anything to the investigator. If she had denied that she lived with her husband, the investigator would have known she was not telling the truth. At that point, this could have become a criminal case.
Instead, her lawyer met with the investigator on her behalf. The investigator initially took a hard line. Because there was no divorce or formal separation agreement, he took the position that the husband's income should have been disclosed on all of the applications and re-certifications. He wanted to send the case to litigation.
We gave the investigator a carefully-prepared presentation on the family situation. We showed that Mr. and Mrs. S. did, in fact, live apart for many months. We also showed him that when they lived apart, Mrs. S. did not receive any support from Mr. S.
The investigator agreed to a reasonable settlement. While Mr. and Mrs. S. had to pay back some of the benefits they received, they were able to settle the case with a no-interest, no-penalty installment plan. Their monthly payments fit within their family's budget.
If you received a letter from the Bureau of Fraud Investigation, you need to act quickly to protect yourself. First, click here to download our free report, "5 Deadly Mistakes in Medicaid Fraud Investigations."
Then, consult with an experienced Medicaid fraud lawyer. Individuals who try to handle these investigations on their own can sometimes make matters worse because they do not realize how much the investigator already knows.
To schedule a consultation with an experienced Medicaid fraud attorney, call The Howley Law Firm today. at (212) 601-2728.
Consulting Work After a Period of Unemployment Results in Claim for Repayment of Benefits
Mr. R. earned a very good income working for a bank, but he was suddenly unemployed when the financial crisis hit. He applied for and received unemployment benefits. He also applied for Medicaid and received Family Health Plus benefits for himself and his family.
One year later, he was still unemployed. Then, after 18 months, he was given some work as a consultant. He had no benefits, and his income was erratic, but at least he could pay his bills and get off unemployment.
When he received a Medicaid recertification form in the mail, he signed it and sent it back without making any changes. He did not check his tax returns to see how much his income was in the past year. As far as he was concerned, his financial situation was still precarious.
Three years later, he received a letter from the Bureau of Fraud Investigation. The letter said that he was under investigation and that he had to come to an "interview" with his tax returns, bank statements, and other financial records.
When he checked his tax returns, Mr. R. realized that he had a problem. His annual income for each of the past three years was above the eligibility limit for Family Health Plus benefits.
Mr. R. called the investigator. He wanted to know what he should do. The investigator refused to tell him anything over the phone. All the investigator would say is that Mr. R.'s case would be "referred to litigation" unless he cooperated with the investigation. When Mr. R. asked if that meant criminal charges, the investigator said that he should just come in for the interview.
Mr. R. decided that he needed a lawyer. After reviewing his financial records, his lawyer met with the investigator and explained the situation. Mr. R. did not attend the initial meeting. He was not put in a position where he might say something that could be used against him, and he was not interrogated by the investigator.
The investigator initially took a hard line because Mr. R.'s annual income exceeded the eligibility limits for Family Health Plus benefits. After speaking with Mr. R's lawyer, however, the investigator agreed to settle the case without any criminal charges or civil litigation. He also agreed to reduce the amount of the claim based on the number of months when Mr. R's monthly income was within the eligibility limits.
Mr. R. was able to settle the investigation by paying back some, but not all, of the Family Health Plus benefits his family received. The case was closed with no criminal charges, no lawsuits, and no impact on his credit report.
If you receive a letter from the Bureau of Fraud Investigation, it means that you are a suspect in a Medicaid fraud investigation. The investigator has the authority to refer your case for criminal prosecution or civil litigation. Anything you say during the investigation may be used against you.
Do not try to handle this on your own. First, click here to download our free report, "5 Deadly Mistake in Medicaid Fraud Investigations."
Then. call John Howley, Esq. at (212) 601-2728 to schedule a consultation with an experienced Medicaid fraud attorney.
John Howley, Esq.
The Howley Law Firm P.C.
350 Fifth Avenue, 59th Floor
New York, New York 10118
Change of Residence to Nassau County Results in Criminal Charges
Mr. & Mrs. S. lived in Queens with their three children and ran a small business out of a nearby storefront. They had just started their business, so they did not have much income. When they applied for Medicaid, they were approved for Family Health Plus benefits.
Two years later, they were able to buy a small home that was in foreclosure. One of their children was now grown, and he stayed in their apartment in Queens. The rest of the family moved into their new home just across the border in Nassau County.
When the Family Health Plus recertification form came in the mail to the Queens address, they signed it without making any changes. They did not disclose that they were now living in Nassau County, which is not part of New York City.
The HRA Bureau of Fraud Investigation found out about their new address through publicly-available property and car registration records. Investigators went to the Long Island home and took photos of the family going into the home with their car parked in the driveway. The investigators also spoke to neighbors in the old Queens neighborhood and learned that only the son lived in the Queens apartment.
When Mr. & Mrs. S. received a letter from the Bureau of Fraud Investigation, they decided to meet with the investigators on their own. They admitted that they bought the home on Long Island, but they claimed that they had only been living there for a few weeks. The rest of the time, they told the investigators, they were living in Queens while the new home was renovated.
The investigators told Mr. & Mrs. S. that their benefits would be terminated because they no longer lived in New York City, but they did not say anything else. Mr. & Mrs. S. went home thinking the investigation was over.
A few months later, NYC Police Officers showed up at their storefront. Mr. & Mrs. S. were handcuffed in front of their children and charged with felonies including filing false statements and grand larceny. They faced up to five years in prison and $25,000 fines on each count, plus restitution of the Medicaid benefits they had received. Because Mr. S. was not a U.S. citizen (he was a permanent resident with a Green Card), he also faced deportation if he was convicted on any of the felony charges.
Mr. & Mrs. S. finally called our office to get legal help. We convinced the District Attorney to reduce the charges to misdemeanors. No jail. No probation. No deportation. They only had to pay a $1,000 fine and restitution of the benefits they had received.
If Mr. & Mrs. S. had called our office when they received the first letter from the Bureaus of Fraud Investigation, we may have been able to avoid criminal charges altogether. In fact, we have settled hundreds of cases without any criminal charges being filed against our clients. But you must get legal help at the very beginning of the investigation.
To download a copy of our free report, "5 Deadly Mistakes in Medicaid Fraud Investigations," click here.
Do not try to handle a Medicaid fraud investigation on your own. If you receive a letter from the Bureau of Fraud Investigation asking you to come in for an "interview," you should call an experienced Medicaid fraud lawyer immediately.
To schedule a confidential consultation with an experienced Medicaid fraud lawyer, call John Howley, Esq. at (212) 601-2728.
John Howley, Esq.
The Howley Law Firm P.C.
350 Fifth Avenue, 59th Floor
New York, New York 10118
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.
John Howley, Esq.
350 Fifth Avenue
New York, NY 10118
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