Joe came to us with a serious problem. He had flat-out lied on his application and re-certifications for Medicaid benefits.
Joe wrote that he earned only $400 per week when, in fact, he owned a business that paid him $4,000 per week. Plus his business paid for the leases on four luxury cars for him, his wife, and their children. The business also took tax deductions for expensive meals at restaurants that probably would not qualify as business expenses if the IRS ever conducted an audit.
Joe was facing the possibility of very serious criminal charges for Medicaid fraud, including felonies that could put him and his wife in prison for several years. The Medicaid fraud investigators could also refer his case to the IRS and other law enforcement agencies for serious civil and criminal investigations.
The Medicaid fraud investigators wanted to see Joe's tax returns and bank statements so they could prove beyond a reasonable doubt that he had lied on his application and re-certifications for Medicaid benefits.
After reviewing Joe's situation, we decided the best option was to negotiate a settlement without turning over any of his financial records.
The investigators presented Joe with a very large claim -- tens of thousands of dollars -- for Medicaid benefits the government had provided to him and his family over a period of six years.
We were able to negotiate two options for Joe to get out of this mess. He could pay the claim in monthly installments over a period of eight years with no penalties or interest. Or he could receive a 25% discount if he paid the claim in full.
Joe took out his checkbook, paid the claim, and received a 25% discount. The Human Resources Administration signed a settlement agreement stating that the payment resolved all claims, that no further action would be taken, and that his case would not be referred to the IRS or any other government agency.
Every Medicaid fraud investigation is different. How you should respond to investigators will depend on your particular facts and circumstances. Sometimes it makes sense to fight back. Other times it makes sense to cooperate and explain your situation. And sometimes it makes sense to settle before things get worse.
Most investigations start with a letter from the Bureau of Fraud Investigation at the Investigation, Revenue and Enforcement Administration. You need to take that letter seriously. How you respond can make the difference between an inconvenience and a criminal record.
Start by calling us at (212) 601-2728 to schedule a confidential consultation. We will discuss your specific situation and help you develop a plan to get through this.
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.