Medicaid Fraud Lawyer in New York City

As a Medicaid fraud lawyer in New York City, I’ve helped many families out of difficult situations. My clients are typically accused of not reporting income or not reporting the man of the household on their application and recertification for welfare benefits. If you think you may be in that kind of situation, and you are being contacted by the Bureau of Fraud Investigation, then you may benefit from information I present in this article.

If you were contacted by the Department of Social Services Bureau of Fraud Investigation, the most important thing to do is to not panic and not call the investigator. Instead, it makes sense to discuss the situation with an attorney. The consultation is free.

If you would like to discuss the letter with me personally, feel free to call me anytime at 212-233-1233. I am a private attorney. I don’t work for the government. Everything you say to me is confidential by law.

I understand that you have a lot of questions. So here are the questions that people ask me all the time when they discuss their Medicaid fraud cases, and my answers, based on my experience dealing with Medicaid fraud investigations.

Should I contact the investigator?

In my opinion, it is best not to contact the investigator. They are trained to get you to provide incriminating information that can be used against you in court. If you talk to the investigator, they will ask to provide more information and will ask to provide documents. They will continue working the case until they build enough of a case to take to court and secure a criminal conviction.

They may ultimately settle the case with no criminal liability. But they like to build a strong criminal case against you first. Which is something that you would rather do without.

Recently, they have also set up an online portal where they ask the targets of their investigation to send them documents. After that, if they receive enough incriminating information about their target, they may refer the case to the District Attorney’s office to prosecute in criminal court.

And this is why speaking to an investigator is a bad idea. Because you will end up providing incriminating evidence against yourself.

If I just ignore the letters, will the case go away?

Just ignoring the investigation is a bad idea, because it will not go away on its own, it will only get escalated to the District Attorney’s Office. That’s because even though they don’t have your testimony, they typically already have enough documentary evidence to build a successful criminal case against you.

This is why the best way to resolve a Medicaid investigation is to have a Medicaid fraud lawyer handle it for you. Medicaid fraud lawyers are trained to protect your rights.

If you need a Medicaid fraud lawyer, we at the Law Offices of Albert Goodwin are here for you. You can call us right away at 212-233-1233.

Should I tell the investigator that I’m in the process of hiring an attorney?

If a Department of Social Services investigator sees that you are not following up, they may try to contact you. You can just tell them that you cannot talk to them. There is no need to worry about disappointing the investigator. They understand that remaining silent is your right and that letting you remain silent is a part of their job.

It’s definitely not a good idea to back to them. Then you are just doing their job for them. Have a Medicaid fraud lawyer follow up with them instead.

I don’t think I need a lawyer. Can I just outsmart the investigator?

An investigator has years of training and experience that you do not have. They have many strategies at their disposal. Here are some examples:

• They can pretend to be friendly
• They can lie to you
• They can threaten you
• They will try to get you to reveal incriminating information that can be used against you by the D.A.
• They can detain you
• They can show their true face and let you know what kind of trouble you’re really in
• They can work in pairs and play good cop-bad cop
• They can make you sign a statement
• They will record everything you say
• They can testify to what you’ve said
• They have the time to be persistent

And what strategies do you have? None.

• Do not talk to the investigator
• Do not be friendly with them
• Do not cry
• Do not give them excuses
• Do not try to show them that you’re a real person, not a criminal from TV
• Do not think that if you’re honest and provide all the (incriminating) information, they will let you go
• Do not tell them you’re a single mom
• Do not beg for their sympathy
• Do not tell them you don’t have money
• Do not tell them you didn’t know
• Do not tell them the children’s father and you are “separated” in your mind
• Do not tell them someone else told you to fill out the application this way
• Do not tell them you don’t know the language
• Do not tell them the change is recent and you didn’t have the time to report it
• Do not them you had no choice
• Do not tell them it’s the government’s fault

If you continue talking to the investigators, you will crack under the pressure. Everyone does.

I already talked to the investigator. Am I in big trouble?

If you did already talked to the investigator, it’s not the end of the world, and there is no need to despair. But speak to a Medicaid fraud attorney as soon as you can, to have the best strategy to remedy the situation.

What kind of evidence do they already have against me?

Here is the kind of evidence the investigator already has:

• Records of everyone who resides in your household
• Records of everyone’s income, from tax returns and employment records
• Records of everyone’s assets, from bank statements and deeds
• Copies of leases
• DMV records
• Records of everyone’s addresses and actual physical place or residence and employment
• Records of usage of the benefits card, including date, time and location
• Photos, videos and recordings

Will I go to jail?

Some people have gone to jail for Medicaid fraud. But that does not mean that you will. What this does mean is that you should speak to a Medicaid fraud lawyer immediately and discuss your legal strategy. Since Medicaid fraud is a crime, Department of Social Services investigations can be escalated and referred to the District Attorney’s office by the Department of Social Services investigator. It is crucial to hire a Medicaid fraud lawyer who is familiar with criminal investigations, in order to increase your chances of a good defense.

What is the penalty for Medicaid fraud?

New York Penal Law 155 describes the sentencing guidelines for someone committing Medicaid fraud. The sentence depends on the total amount received. For most people, the amount received from Medicaid is between over $3,000 and under $50,000, which according to the guidelines can carry a sentence of up to seven years in jail.

If you are prosecuted by the District Attorney’s office and get sentenced, then you will not only have to go to jail but would also have to pay back the benefits received as restitution.

Do I have to pay back the benefits?

The important thing to remember is that the priority is to avoid criminal liability. Having said that, the amount of payback is also important. In some cases, especially when the total amount is very high, and the beneficiary’s eligibility is questionable but plausible, reducing the amount owed for money expended by the Department of Social Services for Medicaid benefits may be possible. Some of the ways we do that are showing a period of eligibility. The Medicaid investigator letter can be an indication of what we are dealing with.

If we can prove to the Department of Social Services that you were eligible in the first place, then it may be possible to avoid benefit payback, and it may be possible to keep your services and benefits. However, most investigated cases have a solid foundation and are difficult to challenge in a significant way.

Can I pay back in installments?

The investigation department’s priority is to collect as much as they can with as much of it upfront as possible. It is possible in some cases to enter into an installment agreement, with assistance from an experienced Medicaid fraud lawyer.

How much does it cost to hire a Medicaid fraud lawyer?

The fee for a Medicaid fraud lawyer to represent you during a Medicaid investigation by the DSS would depend on your situation.

Can I reapply for benefits later?

You can go to your local Medicaid office and reapply if you have just become eligible, even if you were not eligible before.

If a person does not reside in the household, can the department investigation still say that they do?

Even if you claim that a person does not reside in the household, the Human Resource Administration Bureau of Fraud Investigation administration can still consider them to be a part of the household and target them as a part of the Medicaid investigation process. We often see a person not listed as part of the household receiving a Medicaid investigator letter as well. A children’s father is considered to be a part of the household often just by virtue of being the father, and often with the following additional factors:

• spends time in the household
• married to the mother of the children
• list the household address on his tax returns
• claim children as dependents
• claims the mother of the children as a dependent
• has his name on the deed, lease or the utility bills
• provides material support for the family

We’re separated but living together?

We live together, but I am of the opinion that we form separate households, we are two different families, why is the Department of Social Services saying that we are in one household?

The DSS views everyone living in the household as being the same household, even if the people themselves don’t consider themselves that way. The Department of Social Services would be especially concerned if the people in the house are related – let’s say, grandmother or uncle. It’s different if people are just roommates. In a situation where there is a family, especially where the father of the children is not listed on an application or recertification, a fraud investigation is a frequent occurrence.

Is there a way to beat a Medicaid fraud investigation?

There are plenty of strategies to beating a Medicaid fraud investigation. You can read about the 9 things we always do in a Medicaid fraud investigation plus the 5 things you should never do in a Medicaid fraud investigation.

I got a Medicaid investigator letter and it’s unclear. What does it actually say?

Here is the standard text of the letter in its entirety:

NYC Department of Social Services
Human Resources Administration
Office of Program Accountability

INVESTIGATION, REVENUE AND ENFORCEMENT ADMINISTRATION
Bureau of Fraud Investigation
375 Pearl Street, 22nd Floor, NY, NY 10038

Dear Sir or Madam:

This office is conducting an investigation that may lead to a finding that you owe money. Please read this letter completely and with care, so that you understand your rights.

This investigation is about your Supplemental Assistance Program (Snap), Medicaid or Child Health Plus (CHIP) Medical Assistance/Family Health Plus (MA/FHP) Benefits. This is based on information we have showing that you or someone in your household:

Did not report someone in your household
Did not report assets
Did not report income
Is employed and makes money you did not tell us about
Owns property you did not tell us about
Receives rental income you did not tell us about
Did not report the correct residence

We scheduled an interview for you to discuss this matter with us.

Please bring your Photo ID card, this letter and the following document(s):
Bring in proof of Identity and NYC residency
Birth certificate
Marriage Certificate
Mortgage documents
School letter
Income tax documents
Pay stubs last 4 pay stubs
Deed to property
Utility bills

If you need more time to find these documents or need to reschedule the interview, call the investigator.

IMPORTANT NOTICE

You can bring a Medicaid fraud lawyer or another representative to assist you in resolving this matter. You can contact your bar association or a legal services organization to seek free legal representation.

You are entitled to interpretation assistance. Please let us know if you would like us to provide an interpreter in the language that you request.

You may answer questions or choose not to say anything. If you do answer questions, your benefits cannot be stopped or reduced just because you did not answer.

If our investigation finds that you were ineligible for benefits received, we may ask you to repay them. You do not have to sign a repayment agreement. However, if we do not come to an agreement, we may sue you in civil court to get back the amount owed or, in some cases, refer you for criminal prosecution.

You may still be eligible for certain benefits now even if you were not eligible in the past. If you would like to discuss your current eligibility for Medicaid, you can go to your local Medicaid office.

TRAVEL INSTRUCTIONS
(By Train) No. 1 to Franklin Street; A, C, E, to Canal Street; A, E, No.2 & 3 to Chambers St.

Our Office is located at 375 Pearl Street, 22nd Floor.

Do you have a disability or a health condition that makes it hard for you to understand this notice or to do what this notice is asking? Does this condition make it hard for you to get other services at HRA? Call us at 212-331-4640 and we can help you. You can also ask for help when you visit an HRA office. You have a right to ask for this kind of help under the law.

A Medicaid investigator letter can also come from 151 W Broadway, 7^th Floor, New York, NY 10013.

If you think that the Department of Social Services is investigating you for Medicaid fraud, contact a Medicaid fraud lawyer immediately.

I am a Medicaid fraud lawyer. I can speak to the investigator on your behalf and negotiate the best possible outcome for your case. I will be happy to provide you with a free consultation. You can call me at 212-233-1233 or send me an email at [email protected].