Avoiding Medicaid Fraud Investigation Mistakes

New York Medicaid Fraud Investigators Become More Aggressive

There is no such thing as a “routine” Medicaid fraud investigation.  Any suggestion of fraud is very serious and could result in devastating consequences.  You could face claims for repayment and penalties, unilateral withholding of payments, exclusion from the Medicaid program, loss of professional licenses, and criminal charges.

This is especially true in New York, where investigators and prosecutors have become more aggressive.  The New York Office of Medicaid Inspector General (OMIG), the Attorney General’s Medicaid Fraud Control Unit (MFCU), and the City’s Bureau of Fraud Investigation (BFI) do not hesitate to turn your mistakes into criminal charges.

How to Respond to Medicaid Fraud Investigators

Medicaid fraud investigators will often approach you with a request for documents or an interview.  They are trying to get information from you before you contact a lawyer.  Do not fall for that trap.

The investigator already completed a review of all available documentation before they contacted you.  They already interviewed witnesses.  They already believe that you are guilty.  Anything you say to them can and will be used against you.  Do not answer their questions or voluntarily turn over documents until you are fully prepared.

Your first step should be to contact a lawyer who understands the complex regulations governing Medicaid and has experience in government investigations and criminal defense.  If the Medicaid investigators contacted you by letter, give the letter to your lawyer.  It often contains subtle clues to the strengths and weaknesses of their case.

If you are contacted by phone or in person, tell the investigator that you will get back to them because you cannot talk right now.  Get their business card or contact information, then bring that information to your lawyer.  Your lawyer will contact them to find out what they already know and what their concerns are.

How Your Lawyer Can Help

You need to put your lawyer in touch with the investigators immediately.  The best time to resolve a Medicaid fraud investigation is before it is completed.  Your lawyer may be able to take advantage of gaps in the government’s knowledge to cut the investigation short, convince them to drop the investigation, or negotiate a settlement agreement.  At a minimum, your lawyer will learn why the government is investigating you, which is critical to developing your defense strategy.

Your lawyer will also conduct his own investigation.  He will review your situation and records to identify any problem areas and any issues that might come up in the government's investigation.  Together, you will put together the evidence you need to respond forcefully to any claims or charges.

To schedule a consultation with an experienced Medicaid fraud lawyer, call John Howley, Esq. at (212) 601-2728.

You can also click here to download his free e-Book, “How to Survive a Medicaid Fraud Investigation.”