Why Am I Being Investigated for Medicaid Application Fraud?

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:

• You have a different address than the one on your Medicaid application;
• A deed or mortgage shows that you own real estate inconsistent with your income;
• A car title or registration shows that you own cars or have car payments inconsistent with your income;
• Your children go to a private school that is more expensive than your reported income would support;
• Your employer reported that you earn more income than you disclosed to Medicaid;
• You have bank accounts, stocks, bonds, 401-K plans, or other assets that suggest you have more income than you disclosed;
• Other people use your home address as their address, but you did not disclose them or their income to Medicaid;
• Someone blew the whistle and accused you of Medicaid fraud.

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.