New York City Medicaid Fraud Investigations on the Rise - What to Expect If You Are Targeted

Health care coverage in New York these daysthat the duty to update financial eligibility
costs an arm and a leg. Think you can get a ainformation applies immediately upon the change
break by applying for Medicaid? That may be so -occurs. If you are eligible to receive Medicaid and
if you financially qualify. On the other hand, if youbefore your next re-certification become ineligible,
don't think twice before applying because youyou must notify the agency or you will be
may be investigated for fraud sooner than youcommitting fraud.
think.In most Medicaid fraud investigations, investigators
If you have applied for Medicaid in the State ofcatch you before you know that you are under
New York, particularly in New York City, andeye at all. They build their file before you hear
misrepresented facts regarding your income andfrom them. By the time you receive a letter
assets on your application, you may becomefrom an investigative agency asking you to come
another target of relentless and massive hunt forto their office for an "interview" and to bring along
fraudsters. The new initiative that started a fewcertain documentation, the investigation is
years ago across the state has netted thousandspractically completed.
of Medicaid recipients who had received MedicaidIf you receive such letter, you should seek legal
fraudulently. The number of Medicaid fraudadvice immediately before discussing anything with
investigations conducted in the city has increasedinvestigators. If you go to the interview and
substantially. Numerous people were recentlyvoluntarily submit requested information, you may
contacted by New York City Bureau of Fraudbe confessing to having committed a crime and
Investigation and other agencies that routinelyany information you provide may be used in
investigate New York Medicaid fraud.criminal prosecution. In New York, some cases of
As a benefit recipient, you are obligated not onlywillful fraud may be prosecuted as grand larceny
to provide truthful disclosure of your financialand other felony charges. Other legal
status when you apply for Medicaid, but alsoconsequences may include civil law suites, placing
inform the program of any changes in yourliens on property, and being barred from the
income. Many Medicaid fraud cases that haveprogram.
come to my office involved individual recipientsAt the investigative stage of the case, the most
who for this or another reason concealed theiroptimal resolution is avoiding prosecution and your
income and assets.chances of a favorable outcome increase
Many had disclosed a significantly lower incomedramatically if you deal with the investigative
then it really was and many used a fictitiousagency early and in the right way, though your
address or concealed assets. Obviously, mostattorney.
were ineligible to receive Medicaid. Less known is