Sometimes our clients ask why they are being directed to appear for an interview with NYC Medicaid fraud investigators at the investigators’ offices. Usually, a client receives a letter in the mail from an NYC investigator directing them to appear at the Manhattan office for a Medicaid fraud investigation and to bring various financial documents, including income tax returns for the past several years. Other times, though less often, Medicaid fraud investigators may come to the client’s home and attempt to ask questions. In any case, people should know their rights and understand that they are not required to answer the Medicaid fraud investigator’s questions and that they have an absolute right to have an attorney present during any questioning by the investigator.
Our firm’s attorneys have been handling these cases for many years. They have visited the NYC Bureau of Medicaid Fraud numerous times, negotiated with the department’s investigators, and resolved multiple cases with results acceptable to the clients. We strongly advise anyone who receives a letter requesting an interview with a Medicaid fraud investigator, as described above, not to make rash decisions before speaking with an experienced attorney who handles criminal defense and these administrative investigations. Our clients often try to understand why they were called for an interview. There may be various reasons, from a routine audit to an anonymous phone call. If a person works and receives payroll checks, that information is transmitted to the New York State Department of Labor and other city departments. Lists of Medicaid recipients may be compared with payroll databases using computer software to identify potential violations. In other cases, after the initial verification of the Medicaid application, city workers may request a credit report for the applicant. Such a credit report may reveal bank accounts, mortgages, and car rental payments. Whatever the reason for the interview request, it should be taken seriously and handled responsibly. An experienced attorney can help you determine whether you were eligible for free health insurance, including whether you were eligible during one period but not another. If it turns out that a Medicaid recipient was not eligible, New York City may request repayment of all amounts Medicaid spent on medical services for that recipient during the entire period of ineligible enrollment, including monthly premiums paid to private health insurers that sometimes enroll Medicaid recipients. If you ignore the letter and do not attend the interview, the case may be referred to a collection attorney. If the collection attorney’s demands for payment of the disputed amount are ignored, a civil action may be filed. Your credit history may also be negatively affected. In other instances, the case may be referred to the District Attorney’s office, and the person may be arrested. It is usually better to resolve such a case during the administrative investigation.
How can an attorney help? To begin, bring all financial documents, including income tax returns for the past several years, to a consultation so the financial status of the family receiving Medicaid can be assessed. If a review of all eligibility requirements shows that the person was eligible for Medicaid throughout the period in question, they are advised to attend the interview without hesitation and assert their right to be enrolled in Medicaid. Unfortunately, some people complete Medicaid applications inaccurately, underreport or omit their income, conceal that they live with other working household members, or conceal financial assistance from relatives that may be treated as additional income. In that situation, an attorney can help demonstrate Medicaid eligibility for periods when there is a basis for it and use their experience and efforts to seek a resolution involving a substantially reduced repayment to the city, possibly through a payment plan, if acceptable to the client.
In conclusion, in any situation that may have serious legal consequences, including Medicaid fraud investigations, it makes sense to get advice from an experienced attorney who handles such cases before making any decision. If you have any questions about this or other matters, please contact our firm.
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