You are likely reading this because you are being investigated by the Fraud Investigation Unit at the Human Resources Administration. That, in turn, makes it likely that you’ll have to pay back at least some of the benefits that you have received from the Department of Social Services (DSS). After receiving Medicaid, SNAP, Child Health Plus, or other means-tested programs, how much would you have to pay back? The answer to that question depends on several factors:
Premiums vs. Services Provided – Medicaid plans are managed by a private insurance company. Medicaid pays the premiums to the private health insurance company, usually an HMO, and the company is responsible for paying for medical claims. Under those circumstances, the NYC HRA Fraud investigator will usually ask for the pay-back of premiums. The situation would be different with older Medicaid, where the Department of Social Services would pay the providers directly. In old cases, the Fraud Investigator would ask for a pay-back for medical services provided.
The HRA Prefers to have the full amount. If there is a way for the HRA to get the full amount, they will make that a priority. This is their goal, and they will do their best to meet it.
Partial qualification – if the client qualified for at least some of the benefits for at least some of the covered time, that qualification may reduce the amount owed to the Fraud Investigation Unit of the HRA. Your best chance of receiving a partial qualification is having a qualified Medicaid Fraud attorney represent you in negotiations with the City of New York.
Client’s ability to pay – The City of New York would prefer to have the full amount. But it is our position as New York Medicaid Fraud attorneys that the investigators should recognize that clients often do not have the ability to pay back the entire amount. The amount can go back to years of coverage, so we insist that the HRA either offer a partial payment plan or an installment plan.
It is not a good idea to negotiate with the DSS/HRA on your own. If you are being investigated for by DSS/HRA, call an attorney immediately.
Albert Goodwin, Esq. is an attorney with a practice in New York City who represents individuals accused of Medicaid fraud. You can reach him at (212) 233-1233.