What happens after I talk with the Medicaid investigator?

What happens after I talk with the Medicaid investigator

If you are asking what happens after I talk with the Medicaid investigator, you are asking the wrong question. You should not be talking to them in the first place. Do not contact the investigator. They are trained to get you to provide incriminating information that can be used against you in court. They can be nice, or they can be mean, they can play good cop-bad cop, they can be persistent, and you will crack under the pressure. Everyone does. Do not snitch on yourself. Contact an attorney instead. Attorneys are trained to protect your rights. If you need an attorney, Albert Goodwin is here for you. Call us right away at 212-233-1233.

I did talk to the investigator. 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 an attorney immediately and discuss your legal strategy. Since Medicaid and SNAP fraud is a crime, HRA investigations can be escalated and referred to the District Attorney’s office by the HRA’s investigator. It is crucial to hire a fraud defense attorney 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 or SNAP fraud? New York Penal Law 155 describes the sentencing guidelines for someone committing Medicaid or SNAP fraud. The sentence depends on the total amount received. For most people, the amount received from Medicaid or SNAP 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

Restitution. If you decided to talk to the investigator, and end up 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 entire amount? 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, Child Health Plus or SNAP benefits may be possible. Some of the ways we do that are showing a period of eligibility. The letter can be an indication of what we are dealing with.

Is there a way to not pay back any benefits and to keep my services and benefits? 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 the DSS HRA 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 attorney. It’s easier to get low installments on Medicaid cases than on SNAP cases. If you got a letter from the HRA and you are looking for an attorney, you can contact us at [email protected].

How much does it cost to hire an attorney to represent me during a Medicaid or SNAP Medicaid investigation by the DSS/HRA? The fee for a Medicaid fraud or food-stamp fraud attorney would depend on your situation, which will be explained in the letter or during a meeting with the HRA investigator.

Can I get benefits if my situation changed and I am now eligible even though I was not before? You can go to your local Medicaid or SNAP 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 and SNAP investigation process. We often see a person not listed as part of the household receiving a letter from the bureau of fraud investigation 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 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/HRA in New York views everyone living in the household as being the same household, even if the people themselves don’t consider themselves that way. The Medicaid administration 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 or SNAP fraud investigation, even after I talk with the Medicaid investigator? Read about the 9 things we always do in a Medicaid fraud investigation plus the 5 things you should never do in a New York City Medicaid fraud investigation.

Albert Goodwin, Esq. is an attorney who helps people who are in situations when they are faced with the possibility of having to talk with a Medicaid investigator. He also represents clients in defending criminal charges associated with Medicaid and SNAP fraud. You can reach Albert Goodwin, Esq. at 212-233-1233.

Attorney Albert Goodwin

Law Offices of
Albert Goodwin, PLLC
31 W 34 Str, Suite 7058
New York, NY 10001

Tel. 212-233-1233

[email protected]

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