If you are asking what happens after I talk with the Medicaid investigator, the answer is they are going to follow up with you and 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. And this is why speaking to an investigator is a bad idea. Because no matter what happens, you will end up providing incriminating evidence against yourself.
Some of what happens next is up to you. The most important thing to do is not to 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 situation 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.
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.
The investigator 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.
And this is why continuing to speak to a Medicaid investigator is a bad idea. Because you will end up providing more incriminating evidence against yourself.
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.
Table of Contents
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.
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.
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.
If I just ignore the investigator, 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.
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.
If you talked to the investigator, you would have to worry about penalties, jail time and resititution. Here are the factors that you would have to consider.
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.
|Amount Received||Degre of Welfare Fraud||Section of Penal Code||Felony Class||Penalty|
|In excess of $1,000 but not more than $3,000||Fourth Degree||PL 158.10||Class E Felony||up to 4 years in prison|
|In excess of $3,000 but not greater than $50,000||Third Degree||PL 158.15||Class D Felony||up to 7 years in prison|
|In excess of $50,000 but is not more than $1 million||Second Degree||PL 158.20||Class C Felony||up to 15 years in prison|
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
Separated people 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?
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].