Investigated for Medicaid fraud in New York?
If you got a letter from the NYC Bureau of Fraud Investigations, don't go into that interview alone. Talk to an experienced New York Medicaid fraud lawyer before you talk to anyone else.
Free telephone consultation.
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It's not a casual interview
Investigators are building a case. What you say in that room can be used against you if the case is sent to the District Attorney.
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They've already done their homework
By the time this letter arrives, investigators have usually checked your income, bank records, property and address.
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Bring a lawyer, as the letter says
Call before the interview date so a lawyer can contact the investigator and handle the meeting with you.
If investigators show up at your door
Fraud investigators sometimes skip the letter and come to your home or workplace, or talk to your neighbors. Most people react with fear and start talking. That isn't your fault, and trained investigators count on it.
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Be politeStay calm and courteous. Arguing helps no one.
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Don't lie to themA false statement can become a separate problem.
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Don't discuss your caseNot your income, your household or your application.
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Ask for their business cardsYour lawyer will need to know who to call.
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Tell them your lawyer will contact themThen call us. Don't let them search or take anything without a warrant.
How a Medicaid fraud case moves
Most investigations of New York recipients follow the same path. The earlier a lawyer gets involved, the more say you have in where it ends.
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Step 1
Your case is flagged
Usually because records don't match your application: income on the books, a tax return with an address outside NYC, a spouse's income, property, or a tip from someone who reported you.
Who gets investigated -
Step 2
Investigation and interview
HRA's Bureau of Fraud Investigations pulls payroll, bank and property records, then sends an interview letter or visits you in person.
About the BFI -
Step 3
The case is resolved one of three ways
- Settlement with HRA You repay an agreed amount and receive an agreement that you won't be prosecuted or sued. Settlements
- Civil collection The claim goes to a collection law firm that can sue, freeze accounts and garnish wages. Civil litigation
- Criminal referral HRA sends the case to the District Attorney, usually as felony charges. Will I be arrested?
Medicaid recipients
Benefits recipients are most often investigated for:
- Misreporting household income on a benefits application
- Leaving out household members, such as a child's father who lives in the home
- Receiving New York benefits while living somewhere else
- Letting someone else use your Medicaid card
- Changing or forging prescriptions
- Reselling products obtained through Medicaid
Healthcare providers
Doctors, pharmacies, clinics and other providers are most often investigated for:
- Billing Medicaid for services that were never delivered
- Claims for fake services or medical conditions
- Billing for services provided by unlicensed staff
- Billing for injuries from staged car accidents
- Unlawful fee sharing and kickbacks
- Audit findings by the Office of the Medicaid Inspector General
New York Medicaid fraud lawyer
If you're here, you're probably looking for information about Medicaid fraud in New York before you speak with a lawyer. This site collects answers to the questions people ask most once an investigation starts.
Our firm represents people investigated by the Human Resources Administration's Bureau of Fraud Investigations, the Office of the Medicaid Inspector General, the District Attorney and the Attorney General's Office. We also defend people charged with Medicaid fraud and healthcare fraud in state and federal criminal courts.
Medicaid fraud is treated as theft because the government pays for each recipient's coverage every month, whether or not they use any services. When someone receives benefits they weren't entitled to, the state wants that money back, and sometimes it wants a prosecution too.
Cases are often more complicated than they look. Many people never meant to break the rules. Some didn't understand what they had to report, some signed applications that someone else filled out in a language they don't read, and some were misled by caseworkers or service providers. Those facts matter, and they can change how a case ends.
If you're being investigated for Medicaid fraud in New York, read through this site, then call us at (212) 577-6677 for a free telephone consultation.
Common questions
Do I have to go to the HRA Bureau of Fraud Investigations interview?
You don't have to answer investigators' questions without a lawyer, and the letter itself says you may bring one. Ignoring the letter can affect your continued Medicaid eligibility, so the better move is to have a lawyer contact the investigator before the interview date. More about interview letters
Will I be arrested for Medicaid fraud?
It depends on the facts. Cases that reach criminal court usually involve unreported income or assets, or a New York City address used while living somewhere else. Many investigations end in a settlement with HRA instead. If a case is prosecuted, a lawyer can usually arrange a voluntary surrender instead of an arrest at home or work. The arrest process
What are the penalties for Medicaid fraud in New York?
Medicaid fraud cases in New York courts are usually charged as felonies, such as grand larceny and welfare fraud. Sentences range from jail or probation to a fine, conditional discharge or community service. Depending on the case, charges can sometimes be reduced to a misdemeanor or a non-criminal violation, and paying restitution generally improves the outcome. Criminal penalties
Can I be deported for Medicaid fraud?
A conviction for an aggravated felony or a crime involving moral turpitude can lead to deportation. The charge you plead to, the amount of the loss and the sentence all matter, so a non-citizen's case has to be negotiated with immigration consequences in mind from the start. Deportation and Medicaid fraud
What happens if my Medicaid case goes to civil collection?
HRA can send an unpaid claim to a collection law firm that may sue you. A judgment can lead to frozen bank accounts, wage garnishment, liens on property and damaged credit. Claims can often still be negotiated at this stage. Civil litigation
Got the letter? Call before your interview date.
Free telephone consultation with a New York Medicaid fraud lawyer.