Failing to Notify Medicaid that Your Income Increased

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
(212) 601-2728