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.
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.