The Bureau of Fraud Investigation is part of the NYC Human Resources Administration. It is responsible for investigating Medicaid fraud. It has two primary offices at 151 West Broadway and 250 Church Street in Manhattan.
The bureau is staffed with experienced Medicaid fraud investigators. Many of the investigators have degrees in criminal justice, accounting, and related fields. They are trained in investigative techniques, including how to interrogate fraud suspects. They conduct more than 5,000 investigations every year.
You will first learn about the Bureau of Fraud Investigation when you receive a “target letter.” This letter asks you to come in for an “interview” with the investigators. It asks you to bring financial documents, such as tax returns and bank statements, to the “interview.”
The letter is called a “target letter” because it means that you are the target of a Medicaid fraud investigation. The investigators already believe that you have committed fraud. They are not asking for an interview so they can help you. They have built a case against you, and now they want to confront you with their findings.
If you go to the interview alone, they will try to get you to admit that you are guilty of Medicaid fraud. If you refuse, they will cross-examine you with all of the information they have gathered over the past weeks and months.
Long before you ever heard of the Bureau of Fraud Investigation, the investigators were busy building a case against you. They already have your Medicaid applications and re-certifications. They have payroll records from your current and former employers, some of your banking information, credit reports, car registrations and driver’s license, and deeds and mortgage documents if you own any real estate. They also have payroll records and other financial documents for everyone who lives with you.
Before the “interview,” the investigators already conducted site visits to your home. They may have taken pictures of your home, looked inside your windows, and interviewed your neighbors.
If the investigators determine that you committed Medicaid fraud, they will decide what to do next. The most serious cases will be referred to the District Attorney for criminal prosecution that can result in a criminal record, heavy fines, and even a prison sentence. Other cases will be referred to the City’s lawyers, who will sue you for tens of thousands of dollars. Some cases will be settled either by convincing the investigators that you did nothing wrong, or by agreeing to pay back some of the benefits you received.
What will happen in your case? That depends on how you respond to the investigators.
An experienced Medicaid fraud lawyer can help by reviewing your financial documents before anyone talks to the investigators. Your lawyer can identify problems and help you develop a strategy designed to (a) avoid criminal charges, (b) reduce any demands that you pay back benefits, and (c) eliminate any claims for penalties or interest.
To schedule a free and confidential consultation with an experienced Medicaid fraud lawyer, call The Howley Law Firm today at (212) 601-2728.
When clients receive a letter from the Bureau of Fraud Investigation, one of the first questions they ask is: Why did the investigators decide to investigate me?
You are being investigated because the information you provided on your application does not match up with what the investigators see in other records. Sometimes the other records suggest that you earn more money than you disclosed. Other times, the problem is confusion over where you live or who lives with you.
Some of the most common triggers for a Medicaid application fraud investigation are:
By the time you receive a letter from Medicaid fraud investigators, they have already completed most of their investigation. They have reviewed all of your applications and re-certifications for Medicaid benefits. They have compared the information you provided with property records, credit reports, car registration records, school records, and anything else that discloses where you live, where you work, and what you own. They have obtained your payroll records from your current and former employers.
The Bureau of Fraud Investigation letter asks you to come in for an “interview” with fraud investigators. The “interview” is actually an interrogation. Two investigators will put you in a small room with no windows. One will ask you questions and about every aspect of your family and financial life. The other investigator will write down everything you say that helps them build a case against you.
If the investigators believe that you committed a crime, then they will refer your case to the District Attorney for criminal charges. You could face grand larceny and other felony charges that carry a possible sentence of up to five years in prison.
Or the investigators may refer your case to the City’s lawyers, who may sue you for tens of thousands of dollars in benefits, plus interest and court costs.
In either event, anything you say to the investigators may be used against you in a court of law.
You need to get an experienced Medicaid fraud defense lawyer on your side. Your lawyer will review your documents before anything is said or turned over to the investigators. Your lawyer will meet with the investigators, discuss the issues, and in many cases negotiate a resolution that avoids any criminal charges or expensive lawsuits.
In most cases, you can avoid the interview and interrogation by having your lawyer talk to the investigators instead. If the investigators want you to pay back benefits, an experienced lawyer can often negotiate a reduction of their demand, the elimination of any penalties or interest, and a manageable payment plan with monthly installments.
To schedule a free and confidential consultation with an experienced Medicaid fraud defense lawyer, call The Howley Law Firm at (212) 601-2728 today.
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.
Did you receive a letter from the Bureau of Fraud Investigation? Did they ask you to come in for an “interview”?
You are not alone. The Bureau of Fraud Investigation sends out more than 5,000 of these target letters every year. In some cases, it is just a mistake. In other cases, it is a serious matter that can result in criminal charges and even a prison sentence.
What will happen in your case? That depends on how you respond to the letter.
You have received this letter because the Bureau of Fraud Investigation believes that you lied on your application or recertification for benefits. Some of the common problems are: (1) not disclosing all of your income; (2) claiming that you and your partner or spouse are separated when you still live together; (3) not disclosing a change in your income; (4) having living expenses that are higher than your reported income; (5) not disclosing financial assistance from family members or other sources; and (6) continuing to receive Medicaid benefits from NYC after you moved outside the City.
The letter usually asks for tax returns, bank statements, and identification to prove where you live.
What happens next is extremely important. Whatever you do, do NOT ignore this letter. You need to respond. And the best response is based on careful preparation with an experienced Medicaid fraud defense lawyer.
Do not try to handle the investigators on your own. They handle thousands of these investigations every year. If you self-incriminate yourself, they may charge you with serious crimes that can result in heavy fines, a criminal record, and even a prison sentence.
Get an experienced Medicaid fraud lawyer on your side. To schedule a free and confidential consultation, call The Howley Law Firm at (212) 601-2728.
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.
Several times every month, a mother comes into my office with the same problem. The NYC Bureau of Fraud Investigation claims that she committed Medicaid fraud because she did not report income earned by the father of her children.
Many of the women are telling the truth. They really are separated from the father of their children. They may or may not be getting any financial support. They desperately need Medicaid.
Some of the women are not telling the truth. They claim to be separated, but they are not.
Both groups of women can avoid serious consequences if they follow one simple rule: Never lie to the Medicaid fraud investigators.
You do not have to incriminate yourself. You have the right to remain silent. You also have the right to be represented by a lawyer. And if you handle the investigation properly, you can usually avoid serious consequences.
But if you lie to the investigators, they will show no mercy.
The medicaid fraud investigators already know where everyone lives, works, and gets their mail. They have obtained copies of each parent's driver's license, car registration, and pay stubs showing the addresses they use for their cars and paychecks. The investigators may have addresses from your credit reports, bank statements or credit card statements. They have sat outside your home watching, talking to neighbors, and taking pictures.
In one recent case, a woman went to see the investigator on her own. She told the investigator that her husband lived alone in Pennsylvania, and that she lived in Brooklyn with the children.
The investigator, however, had the husband's cell phone and EZ-Pass records, which showed that his cell phone and car never left the five boros of New York City.
By the time the woman came to see me, she and her husband had been arrested, fingerprinted, and charged with serious felonies. They ended up pleading guilty to misdemeanors, paying a fine, but thankfully avoiding prison.
In another recent case, a couple admitted to me that they falsely stated that they were separated on their Medicaid application and recertifications. I went to see the investigator, alone, and negotiated a settlement before any criminal charges were filed. My clients never had to face questioning by the investigators. I even negotiated a payment plan, so they could pay back benefits over time with no penalties and no interest.
The lesson is simple. Do not lie to Medicaid fraud investigators. In fact, do not talk to investigators alone. Get an experienced Medicaid fraud defense attorney on your side.
To schedule a free and confidential consultation with an experienced Medicaid fraud lawyer, call The Howley Law Firm today at (212) 601-2728.
Medicaid fraud investigations are like a cancer. Early detection and response by an experienced professional can greatly increase your chances of survival.
The Medicaid fraud investigators will decide whether or not to refer your case for criminal prosecution. The consequences of that decision are serious. A criminal prosecution may result in heavy fines, a criminal record, a prison sentence, loss of professional licenses and, if you are not a U.S. citizen, deportation.
You do not want the investigators to make that decision without first considering the evidence in your favor.
The first step is to retain an experienced Medicaid fraud lawyer who is intimately familiar with these types of investigations. By discussing your case with the investigators early in the process, your lawyer can find out what is bothering them, how strong their case is, and where the weaknesses in their case are.
In some cases, your lawyer may be able to provide information that helps the investigators decide not to charge you with a crime. In every case, getting information from the investigators early in the process helps you develop your defenses.
Investigators have the most flexibility early in the process, before a final decision is made. They may decide to drop the investigation based on evidence you provide through your lawyer. Or they may agree to settle the case by having you pay back money. Or they may enter into a cooperation agreement with you if you have evidence against other people they are investigating. Or they may decide to charge only minor crimes, instead of major felonies.
Many of these options disappear, however, once the investigators refer your case for criminal prosecution. At that point, the prosecutor will usually insist on some form of guilty plea and much higher financial penalties.
Simply put, acting quickly to address a Medicaid fraud investigation is your best, and possibly your last, chance of avoiding a criminal record.
To schedule a free and confidential consultation with an experienced Medicaid fraud attorney, call The Howley Law Firm today at (212) 601-2728.
Every week, Medicaid recipients receive letters from the Bureau of Fraud Investigation at the NYC Human Resources Administration. The letters ask you to come in for an "interview" with a Medicaid fraud investigator. They also ask you to bring your tax returns and other documents.
Most people think the investigator wants your tax returns to verify your income. That is not the primary reason. The fact is, the investigator already has your income records. Long before you received that letter, the investigator asked your current and former employers for your payroll records. The investigator already knows how much you were paid.
The investigator wants your tax returns to get other information that will help them prove you committed fraud. Here is some of the information the investigator wants to see on your tax returns:
Your Address: New York City has the most generous Medicaid program, much more generous than New Jersey, Long Island, or Westchester. But only New York City residents are eligible for NYC Medicaid benefits. If you used a New York City address to obtain Medicaid benefits, but the address on your tax returns is outside the City, you could face serious criminal charges for fraud. You need to call an experienced Medicaid fraud attorney before you meet with the investigator or turn over any documents.
Your Marital Status: If you claimed that you were single or separated on your Medicaid application, but your tax returns were filed jointly with your spouse, you have a serious problem. Better call an experienced Medicaid fraud attorney before you see the investigator or turn over any documents.
Your Deductions: If you own a home, you probably deduct the mortgage interest you paid last year on your tax returns. There is nothing wrong with that. In fact, you may own a home and receive Medicaid if your income is low enough to qualify for benefits. The problem is when your mortgage interest deduction is suspiciously high. For example, if you claimed on your Medicaid application that you earned less than $25,000 per year, but your tax returns show that you claimed $15,000 in mortgage interest payments, the investigator will suspect that you had another source of income or financial support.
Unreported Income and Financial Support: Most people think they cannot be accused of fraud if they submitted their recent pay stubs when they applied for Medicaid. This is not true. You are required to disclose all income and financial support on your Medicaid application - including income that may not appear on your pay stubs. This is a very complicated issue. For example, if you took a lump sum payment from your IRA or 401-k, that is not considered income for purposes of Medicaid. But if you took the same amount of money from your IRA or 401-k in monthly installments, that may be considered income. Do not guess. Get advice from an expert.
These are just a few of the issues that can get you into serious trouble in a Medicaid fraud investigation. Before you meet with the investigator or turn over any documents, click here to download a free copy of our Special Report, "5 Deadly Mistakes in Medicaid Fraud Investigations."
To arrange a confidential consultation with an experienced Medicaid fraud attorney, call The Howley Law Firm today at (212) 601-2728.
When the government investigates you for Medicare or Medicaid fraud, it has tremendous resources on its side. The FBI, the HHS Office of Inspector General (OIG), the Centers for Medicare & Medicaid Services (CMS), the Medicaid Fraud Control Unit, and federal and state prosecutors are just a few of the entities that will work together to build a case against you.
You need an experienced criminal defense attorney who understands complex health care laws and regulations. Most of all, you need a trial lawyer who will fight to protect your rights.
John Howley, Esq. has more than 25 years of experience representing clients in complex health care investigations, criminal prosecutions, and civil lawsuits. His clients have included major pharmaceutical companies, individual physicians, physician practice groups, nurses, pharmacists, physical therapists, and healthcare entrepreneurs.
Defending Against Medicare and Medicaid Fraud Claims
Medicare and Medicaid fraud are serious crimes. If convicted of a felony, you could face up to 25 years in prison. You need an experience healthcare fraud criminal defense attorney to avoid potentially devastating consequences.
Early intervention by an experienced trial lawyer is your best defense. By negotiating with investigators and prosecutors before charges are filed, your lawyer may be able to resolve the dispute without criminal charges or at least lessen their severity.
Once charges are filed, you may have viable defenses. Government investigators may not have all the facts. The credibility and motives of witnesses may be attacked. Motions may be filed to dismiss or limit the charges. Once again, getting an experienced criminal defense attorney involved as soon as possible is critical to building a strong defense.
Do not go into an investigation alone. Remember that the government investigators already believe that you are guilty. Anything you say can and will be used against you. Before you answer any questions or turn over any documents, retain a trial lawyer who specializes in Medicare and Medicaid fraud investigations and defense. Let an experienced advocate help you develop a strategy, prepare a defense, develop the evidence, and present your case.
Protecting Your Freedom, Your Professional License, and Your Livelihood
How you handle a Medicare or Medicaid fraud investigation will impact the rest of your professional career. Even if you avoid criminal prosecution, your professional license could be suspended or revoked, and you could be excluded from government healthcare programs. You could also face financially devastating fines, penalties, and restitution orders.
You need a criminal defense attorney who will be both an aggressive defender of your rights in the criminal proceedings and a smart advocate before licensing and regulatory authorities.
Retaining an Experienced Medicare and Medicaid Fraud Lawyer
John Howley, Esq. has more than 25 years of experience representing healthcare providers. His practice is focused on representing physicians, pharmacists, nurses, medical office staff, and healthcare entrepreneurs in Medicare and Medicaid fraud investigations, criminal prosecutions, the defense of professional licenses, and exclusion appeals.
In recognition of his work as a criminal defense attorney, Mr. Howley has received the Gideon Champion of Justice Award from the New York State Association of Criminal Defense Lawyers, the Thurgood Marshall Award from the New York City Bar Association, and the Medal for Excellence in Advocacy from the American College of Trial Lawyers. He has also been named one of New York's SuperLawyers and one of the Ten Best Criminal Defense Lawyers in New York based on client satisfaction.
If you are under investigation or have been charged with Medicare or Medicaid fraud, then you should click here to download our free report, "5 Deadly Mistakes in Medicaid Fraud Investigations."
To schedule a consultation with an experienced Medicaid fraud defense lawyer, call The Howley Law Firm today at (212) 601-2728.
Family Health Plus and Medicaid Fraud Investigations
A Medicaid fraud investigation often begins with a letter from an investigator with the Bureau of Fraud Investigation. The letter may ask you to turn over documents and meet with an investigator for an "interview."
By the time you get this letter, the investigator has already gathered evidence against you. The investigator already believes that you have engaged in fraud. Anything you say at this point can and will be used against you.
Do not try to handle this on your own. One wrong step could result in criminal charges being filed against you. You should contact an experienced Medicaid fraud lawyer immediately, before you say anything to the investigator.
An experienced Medicaid fraud lawyer can help you understand your rights, prepare your defense, and explain your options. Your lawyer can negotiate with the investigator on your behalf. In many cases, hiring a lawyer will save you time, money, and potentially serious civil and criminal consequences.
To schedule a consultation with an experienced Medicaid fraud lawyer, call John Howley, Esq. at (212) 601-2728.
Answers to Frequently Asked Questions (FAQ)
Why am I being investigated?
The Medicaid fraud investigator has information that suggests you are not qualified for benefits. This information may include payroll records, car registrations, property records, and business records. The investigator may have spoken with your employer, your co-workers, or your neighbors.
What are my rights during the investigation?
You have the right to bring an attorney with you to any interviews or meetings with the investigator. You also have the right to consult with your lawyer before providing any documents or answering any questions.
You have the right to remain silent. You do not have to answer the investigator's questions. If you are a Family Health Plus or Medicaid recipient, your benefits cannot be stopped solely because you refused to answer questions.
Should I answer the investigator's questions?
How you respond to the investigation depends on your particular facts and circumstances. Some questions and requests for documents are appropriate. Others may be improper. Sometimes it makes sense to cooperate with the investigator and negotiate a resolution. Other times you must fight to protect your rights.
You need an experienced Medicaid fraud lawyer on your side to help you make these decisions. To arrange a free consultation, call John Howley, Esq. at (212) 601-2728.
What are the possible penalties and consequences?
Medicaid fraud penalties range from repayment of Medicaid benefits to harsh prison sentences. Some of the possible consequences are:
Will the investigator negotiate a settlement?
Depending on the nature of the problem, the investigator may be willing to negotiate a financial settlement to avoid any court cases or criminal prosecution. An experienced Medicaid fraud attorney can help you by negotiating a settlement that reduces the amount owed, by avoiding penalties and interest - and, most importantly, by negotiating an agreement that your case will not be referred for criminal prosecution.
What is Medicaid fraud?
When a recipient of Medicaid or Family Health Plus benefits is investigated, the investigator may suspect that the recipient did not tell the truth or failed to disclose all of their income and assets when they applied for benefits. Some common types of Medicaid fraud involving recipients include:
What is the Bureau of Fraud Investigation?
The Bureau of Fraud Investigation (BFI) conducts investigations of individuals and organized groups who are suspected of committing Medicaid fraud. It is part of the NYC Human Resources Administration's Office of Investigation. Investigations by the BFI may result in Administrative Disqualification Hearings, lawsuits to recover money, or referrals to the District Attorney for criminal prosecution. BFI investigators work out of offices at 151 West Broadway in Manhattan.
Who is the investigator?
Medicaid investigators are trained professionals who know how to conduct a thorough investigation. They work together with other investigators who have 10, 20, and even 30 years of experience investigating thousands of Medicaid fraud cases. They are supported by data analysts, financial auditors, and medical experts.
Free Report and Confidential Consultation
You do not have to face a Medicaid fraud investigation on your own. First, click here to download our free report, "5 Deadly Mistakes in Medicaid Fraud Investigations." Then call our law offices at (212) 601-2728 to schedule a consultation with an experienced Medicaid fraud defense lawyer.
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.