A letter from an investigator at the HRA Bureau of Fraud Investigation must be taken seriously. While most investigations are resolved by negotiating a settlement with the investigator -- even if you are guilty of fraud -- many investigations result in criminal charges or civil lawsuits. The difference usually depends on how you respond to the investigator.
Here are answers to the questions we get most often from clients facing Medicaid fraud investigations.
Why did I receive a letter from the NYC Human Resources Administration, Bureau of Fraud Investigation?
The investigator believes that you provided false or incomplete information on your Medicaid application or re-certifications. They are trying to determine whether you were eligible for Medicaid benefits.
Why did the Bureau of Fraud Investigation decide to investigate me for Medicaid fraud?
Most Medicaid fraud investigations begin when the Bureau of Fraud Investigation finds evidence that is inconsistent with the income or residence you listed on your re-certifications for Medicaid benefits. Investigators have access to databases that contain summaries of your bank account balances, car registrations and titles, real estate titles and mortgages, corporate records, licensing records, and bank lease or loan records. If they discover a high bank balance, a new car lease, or home ownership that is inconsistent with your reported income, they will open an investigation.
What are my rights during a Medicaid fraud investigation at the HRA?
You have the right to consult with an attorney. You have the right to bring an attorney or other representative with you to any meetings with investigators. You have the right to remain silent. You cannot be compelled to answer the investigator’s questions. The investigator cannot terminate your Medicaid benefits just because you refused to answer their questions, but your benefits may be terminated if you are not eligible.
Should I go to the “interview” with the investigator?
No. The “interview” is actually an interrogation by two investigators in a small, windowless room. They will try to get you to admit that you committed Medicaid fraud. Anything you say to the investigators can and will be used against you. If you admit that you signed re-certifications containing false information, the investigators may send your case to the District Attorney for criminal prosecution.
Should I cooperate with the investigator?
That depends. As a general rule, you should find out what the investigators know and what they intend to do with your case before you cooperate. That is very difficult to do if you are representing yourself. The investigators will press you to produce your tax returns and answer their questions first, before they tell you anything. A lawyer, however, can usually find out what the investigators already know – and whether they are willing to discuss a settlement – before you answer any questions. In many cases, your lawyer can resolve the investigation without an interview.
What are the possible consequences of an HRA investigation?
The penalties vary depending on the specific facts of each case. If you were not eligible for Medicaid benefits, but the investigator cannot prove that you intentionally lied on your application or re-certifications, then you can usually avoid any civil litigation or criminal charges. But if the investigator can prove that you intentionally provided false information, your case may be sent to the District Attorney for criminal prosecution. Criminal charges can result in monetary fines, penalties, restitution orders, a jail or prison sentence, and a permanent criminal record.
What if an agent filled out the Medicaid application or re-certifications for me?
You are still liable for any false statements on a Medicaid application or re-certification, even if someone else completed the form for you. You signed the form under penalty of perjury and swore that all the information was true and correct. You accepted the benefits that Medicaid provided. While the agent may also be guilty of fraud, it does not lessen your liability.
Will the investigator negotiate a settlement?
Many cases are settled by paying back benefits that were received when the client was not qualified. In some cases, the investigators will agree to a monthly payment plan with no penalties or interest. The key is how you handle the investigation.
The best place to start is by consulting an experienced Medicaid fraud lawyer. Your lawyer can review your financial records, discuss your situation, and obtain copies of your application and re-certifications from the investigator. Based on this information, your lawyer can develop a strategy designed to avoid criminal charges and reduce the amount of any settlement.
To schedule a free and confidential consultation with an experienced Medicaid fraud lawyer, call John Howley, Esq. today at (212) 601-2728.