Medicaid Application Fraud: How to Respond to a Bureau of Fraud Investigation Letter

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.