Medicaid Fraud Control Unit Investigations in New York

The Medicaid Fraud Control Unit (MFCU) is the largest unit in the New York Attorney General’s Criminal Division.  It is charged with investigating and prosecuting Medicaid fraud by doctors, dentists, nurses, pharmacists, hospitals, nursing homes, durable medical equipment suppliers, and other healthcare providers.

The MFCU targets providers who submit false claims to Medicaid.  False claims include billing for services that were never provided, “upcoding” or overbilling for services that were provided, “unbundling” services to obtain higher reimbursements, billing for an unlicensed or excluded provider under a different provider’s name, paying or receiving kickbacks in return for patient referrals, and providing substandard care, drugs or medical equipment to patients.  The MFCU also investigates and prosecutes abuse and neglect in nursing homes and other healthcare facilities.

With almost 300 professional staff, the New York Medicaid Fraud Control Unit is the largest in the nation.  Its prosecutors, investigators, and forensic accountants and auditors are highly experienced and aggressive.  Every year, they obtain criminal convictions with long prison sentences and recover more than $350 million from healthcare providers accused of Medicaid fraud.

MFCU investigations often begin slowly and build over a period of months and even years.  By the time you are contacted, the MFCU investigators have already uncovered evidence suggesting that you are guilty of Medicaid fraud.  Anything you say to them can and will be used against you.  Keep in mind that the investigators are not there to help you.  They are conducting an investigation to build a criminal case against you.

The investigators may demand that you turn over documents and files.  Some of these demands may be legitimate, but the investigators may also demand records that you are not required to turn over.  For example, you are not required to turn over records that do not relate to Medicaid claims.  Turning over more documents than you are required to disclose can greatly expand the investigation and the potential exposure. 

Criminal charges for Medicaid fraud can be catastrophic.  In addition to facing a long prison sentence and a permanent criminal record, you could be ordered to pay back hundreds of thousands of dollars or more in restitution.  You could also lose your professional license and be excluded from the Medicare and Medicaid programs, effectively ending your career.

If you are contacted by the Medicaid Fraud Control Unit, you should retain an experienced Medicaid fraud defense lawyer immediately.  Your best chance of avoiding criminal charges is to get an experienced lawyer involved before you speak to investigators and before any charges are filed against you.

John Howley, Esq. has more than 27 years of experience defending clients in criminal investigations and at trial, including physicians, pharmaceutical companies, pharmacists, dentists, nurses, physical therapists, durable medical equipment suppliers, and other healthcare providers.  To schedule a consultation, contact him directly at 212-601-2728.