Medicaid Fraud Control Unit Investigations in New York

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.