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.
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.