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NYC Medicaid Fraud Lawyer | Medicaid Fraud Attorney NYC

Medicaid is health insurance program provided by New York State for people who meed certain income and asset thresholds. In Brooklyn, Bronx, Queens, Staten Island law24/7

Letter from Bureau of Fraud Investigation at Human Resource Administration

If you are the recipient of a target letter from an investigator at the Bureau of Fraud Investigators at the Human Resources Administration (“HRA”) for potential fraud this means that you have come on to one of the many Investigators radars for some reason. This could be for any of the following:

  • Your name appears on the deed to real estate either in New York State or outside of New York State
  • Your name appears on the title to a car or multiple cars
  • Your children go to private school
  • Your employer has reported your income that affects your eligibility
  • You have bank accounts, stocks, bonds, 401K or other investment assets that affect your eligibility
  • Another individual has reported you for fraud

If the case has started off at this level, the first letter that you will receive will be from the: Investigation Revenue and Enforcement Administration Bureau of Fraud Investigation either at the old office address: 250 Church Street, 3rd Floor New York, NY 10013 or from their new office address: 151 West Broadway, 7th Floor New York, NY 10013. The letter will state that Bureau of Fraud Investigation office is conducting an investigation into your eligibility for medicaid and that an interview has been scheduled for you to come down to their offices to discuss this matter. The target letter fails to tell you that if at any point throughout their investigation it is apparent that there is criminal culpability they will likely refer the case out to the local District Attorneys office for prosecution or that if the civil liability is clear they might refer the case out to one of the law firms that represents the city in these matters. Recently, the firm of Leoopld Gross & Somers, P.C. at 16 Court Street has been handling the collection and litigation on the civil side for New York City.

George FernandezGeorge Fernandez
14:16 30 Apr 24
Excellent 10 out of 10, Helped resolve my case. Jeremy explained everything and made everything easy to understand.
21:33 24 Apr 24
If you are looking for a lawyer that listens, is aggressive where needed, and holds his word above all else, Todd is the best pick. I had hired multiple attorneys prior to hiring the Spodek Group for a white collar case. The first thing that stood out to me was the cost, as anyone going through the process and dealing with the system, money was tight at that time - especially after hiring and firing multiple lawyers. The cost was not as high as others which was definitely a plus. Todd's intake process was also unlike other attorneys. He took the time to actually listen. He cared. He was trying to put himself in my shoes while I was explaining the situation to him and he really took the time to understand the whole situation. Other lawyers will give you 15 mins and send you a retainer agreement. Not Todd, I think he spent almost two hours with me as I was explaining everything.Not only was he great during the onboarding process, he was supportive and very informative through the entire plea process and eventually sentencing. After hiring him, I asked if I should hire a prison consultant, he told me to save my money as he would do everything they would. He was right and held up to his word. Later on I would hear from others that went with the prison consultants that they were a waste of money - I am glad I listened to Todd!When it came time for sentencing, two days prior to sentencing, the prosecutor tried increasing my proposed prison time by almost double - apparently a normal move. Todd and his team worked with me non-stop through the weekend prior to sentencing to ensure that I was not given additional prison time. Again, he took the time to listen and came up with a strategy to explain the case with great detail.Unfortunately, I did plead guilty as that was my best option. Todd and his whole team wrote up nearly 300 pages of a summary of what happened and why I should not be given prison time. If I breakdown the amount I spent with Todd versus the amount of work that I saw being done, I am shocked I was not charged four times as much. The other benefit was, a lot of criminal defense lawyers were just a single attorney with a paralegal or two. Todd had a team of people that I dealt with (5-7 people that I interacted with), but he was ALWAYS accessible. It would never take him more than an hour to reply unless he was in court.I was sentenced to prison and I was emotionally distraught. Todd and his team did whatever they could even after sentencing to make sure I was alright. He personally stayed in touch with my family to ensure I was doing alright and offered support to them. Most lawyers would consider the job complete at sentencing, not Todd.After prison, Todd still spent time with me to make sure I was on the right track and avoiding any potential risks in the future. He has also been giving advice on how to navigate probation etc and has not been looking at the clock for billing.Although I wish I had never been arrested in the first place, I am glad I had Todd and his team in my corner. Without them I likely would have had to spend a lot more time in prison than I did.Thank you, Todd, and the entire Spodek Law team, for helping turn what was a nightmare into a manageable situation!
Yelva Saint-PreuxYelva Saint-Preux
19:26 19 Apr 24
I am immensely grateful to the entire team at Spodek Law Group for their unwavering dedication and exceptional expertise throughout my case. From our initial consultation to the final resolution, their professionalism and tireless advocacy made all the difference. Their strategic approach and attention to detail instilled confidence in me every step of the way.Thanks to their hard work and commitment, we achieved a truly favorable outcome that exceeded my expectations. Not only did they navigate the complexities of my case with precision, but they also provided invaluable support and guidance during what was undoubtedly a challenging time. I cannot recommend Spodek Law Group highly enough, especially attorneys Todd Spodek and Claire Banks; they are beacons of excellence in the legal profession.YSP.
Katherine SunKatherine Sun
18:08 18 Apr 24
my lawyer is Alex Zhik. Efficient, patient and professional
Nun yaNun ya
17:48 18 Apr 24
Todd, Ralph and Alex are amazing. Helped my husband get from a double digit number with multiple charges to a single digit, by the time I blink he will be out. They very professional and help with all your needs. They dealt with my anxiety and worry very well and they understand that your family member needs to get home as soon as possible.
Keisha ParrisKeisha Parris
20:45 15 Mar 24
Believe every single review here about Alex Z!! From our initial consultation, it was evident that Alex possessed a profound understanding of criminal law and a fierce dedication to his clients rights. Throughout the entirety of my case, Alex exhibited unparalleled professionalism and unwavering commitment. What sets Alex apart is not only his legal expertise but also his genuine compassion for his clients. He took the time to thoroughly explain my case, alleviating any concerns I had along the way. His exact words were “I’m not worried about it”. His unwavering support and guidance were invaluable throughout the entire process. I am immensely grateful for Alex's exceptional legal representation and wholeheartedly recommend his services to anyone in need of a skilled criminal defense attorney. Alex Z is not just a lawyer; he is a beacon of hope for those navigating the complexities of the legal system. If you find yourself in need of a dedicated and competent legal advocate, look no further than Alex Z.
Taïko BeautyTaïko Beauty
16:26 15 Mar 24
I don’t know where to start, I can write a novel about this firm, but one thing I will say is that having my best interest was their main priority since the beginning of my case which was back in Winter 2019. Miss Claire Banks, one of the best Attorneys in the firm represented me very well and was very professional, respectful, and truthful. Not once did she leave me in the dark, in fact she presented all options and routes that could possibly be considered for my case and she reinsured me that no matter what I decided to do, her and the team will have my back and that’s exactly what happened. Not only will I be liberated from this case, also, I will enjoy my freedom and continue to be a mother to my first born son and will have no restrictions with accomplishing my goals in life. Now that’s what I call victory!! I thank the Lord, My mother, Claire, and the Spodek team for standing by me and fighting with me. Words can’t describe how grateful I am to have the opportunity to work with this team. I’m very satisfied, very pleased with their performance, their hard work, and their diligence.Thank you team!
K MarK Mar
01:37 25 Jan 24
I recently had Spodek Law Group represent me for a legal matter in NYC and I am thoroughly impressed with their services.Alex Zhik secured the best possible outcome for my case.It was a seamless journey from the initial consultation to the resolution of my legal matter. From the moment I spoke to Todd about my case, his enthusiasm to help was evident, setting a positive tone for the entire experience. The efficiency and professionalism displayed by the team is commendable.A particularly noteworthy aspect of their service is their user-friendly portal to upload your documents/evidence. This not only simplified the process, but showcases their commitment to streamline the client experience.Lastly, in an industry where legal fees can often be a concern, I found their pricing to be very reasonable, making needing legal assistance feel accessible and stress-free.I am grateful for their support and wouldn't hesitate to turn to them again in the future.

Either way, whatever you say and do – will be held against you in court. Our NY medicaid fraud law firm can help ensure you don’t make any harmful statements. The ideal situation for the HRA investigators is that you come down to the scheduled meeting, disclose all of your finances and provide them with all of the corroborating documentation to prove your ineligibility or worse that you intentionally committed fraud. Now, the investigators have leveraged the situation and they can demand an inordinate amount of money from you and leave you with few viable options.

The initial target letter itself itself will give you a good idea of the type of evidence that they already have against you and the stage of their investigation. Depending on the specific facts and circumstances of your case, the requested items will change. The target letter will generally ask for the some of the following documents when you come down for your interview. If you work with us, our NYC medicaid fraud lawyers can help you during the interview.

  • Photo ID, and a copy of the target letter
  • Business bank book for the years under investigation
  • Personal bank book for the years under investigation
  • Drivers license
  • Income tax documentation for the business for the years under investigation
  • Income tax documentation for your personal returns for the years under investigation
  • Last 4 pay-stubs
  • Pension/401K/IRA Statements
  • Utility bills
  • Cell phone bills
  • Business records
  • Dissolution records
  • All mortgage documents/applications for any properties
  • Deed of any properties
  • Letter certifying where your children attend school
  • Marriage certificate/divorce papers
  • Birth certificate for any children
  • Vehicle registration/car payments/insurance

The issue with Medicaid fraud in New York is that often times applicants fail to realize that not only do you need to qualify when you initially applied, but you have an affirmative responsibility to update the appropriate agencies with any changes in your income and/or your assets. Every application you swear under penalty of perjury that your information is truthful and accurate. Often times, people forget that their income has gone up, or that they got married or any other factor that could effect their eligibility.

The Access NY Health Care application requests information for all members of the household. This includes the names and details of parents, step-parents and spouses. In a lot of cases, applicants will put a NYC address when they in fact live in New Jersey, or long island. In some cases, applicants put their NYC business address and they live elsewhere. The Access NY Health Care application also requires that the applicant detail the type of money and the amount received by all members of the household. Medicaid applicants are required to send in proof regarding their income. This is often where applicants get in trouble. Medicaid applicants under report their income, or have an individual state that they are an employee when they in fact own or operate the business. The Access NY Health Care application requires that applicants disclose all earnings from work such as wages, salaries, commissions, tips, overtime and money earned from self-employment. In addition, applicants must include “unearned income” such as social security benefits, disability payments, unemployment payments, interest and dividends, veterans benefits, workers compensation, child support payments/alimony, rental income, pension, annuities and trust income. The Access NY Health Care application requires details as to contributions such as money from relative or friends, roomers or boarders. This broad definition includes any money that was received to help meet living expenses. Lastly the application requires information regarding any temporary (cash) assistance, supplemental security income (SSI) payments, student loans or grants. If an applicants puts down that he or she and/or the household members have no income – then medicaid is going to want to know how you are living and supporting yourself. Are you living with friend or relatives? Did anyone recent quit their jobs? changed jobs? Is anyone a student in a vocational, undergraduate or graduate program? Are there child care expenses? What are your housing expenses? Is there rent, mortgage, and property taxes? Do you pay for water separately? The Access NY Health Care application requires that proof be sent in.

NYC Medicaid Fraud Attorneys – 24/7 Help

Often times during the investigation, the bureau of fraud investigations will send out a team to investigate an applicant. The investigators will go out and do surveillance of the applicants house, work and even the school the children attend to. In certain situations, the investigators will interview neighbors, friends and associates in attempt to build their case. Our NYC medicaid fraud lawyers can help prevent the investigators from overstepping and overreaching.

NYC Medicaid Fraud Lawyer

Human Resources Administration and the Department of Social Services provides short term assistance to New Yorkers with social service and economic needs. This includes various benefits: temporary cash assistance, medicaid, family health plus, child care, food stamps, home care for disabled individuals, home care for senior citizens, protective services for adults, domestic violence support, child support enforcement, and assistance for those who have HIV/AIDS. The programs of HRA are designed to assist those who qualify.

The Investigation, Revenue and Enforcement Administration (“IREA”) is the division that is responsible for supporting HRA and making sure that there is public trust in the benefits system. The IREA is divided further into three separate agencies, with three distinct roles:

The Office of Investigation
The Office of Medicaid Provider Fraud and Abuse Investigation
The Office of Revenue and Administration
If it could not get any complicated, each one of these divisions has separate subdivisions.

The Office of Investigation has three subdivisions

1. Bureau of Fraud Investigation (BFI). The BFI is required by law to conduct investigations of individuals and organized groups allegedly attempting or committing to commit fraud against the various social service programs administered by the Human Resources Administration. These investigations can lead to administrative disqualification hearings, civil litigation, and/or referrals for criminal prosecution.

Division of Claims and Collections

The Division of Claims and Collections is a revenue division within the HRA’s Investigation, Revenue and Enforcement division. The Division of Claims and Collections pursues the collection of money and monitors the repayment of money owed by the current and former HRA claimants who received benefits that they are now repaying. This could be cash assistance or medicaid.

The Division of Claims and Collections is located on the 12th Floor of 250 Church Street. They often send out target letters with the case number on the top right side. The letter will stat the following:
It has recently come to our attention that an incorrect payment of Medicaid payments was made on your behalf under the above referenced case number. The claim amount of $_______________ was an incorrect payment due to the employment noted below. This income rendered you ineligible for Medicaid services. Accordingly, the agency must recover the cost of services paid in error.

Next, it will likely list the employer, that dates the claimant was initially employed and how much the claim amount is. The recipient of this type target letter must consider a few things:

  • Is this amount correct?
  • Does this amount include late fees, penalties, interest?
  • Were there period I was eligible, and periods I wasn’t eligible?
  • Does this claim amount cover me, my spouse, my children?
  • What about the time period before this claim? Or after this claim? Does this settlement cover the full time period I recieved benefits?
  • In the event that I pay this amount, what am I admitting to if anything?
  • In the event that I refuse to pay what will the next steps be?
  • How will this affect any professional licenses I have?

The Human Resources Administration (“HRA”) will usually include an Agreement of Voluntary Repayment form (CC-112) and request that you either pay a lump sum or make monthly installment payments. If you are to repay it monthly, they will give you 12 month’s to repay the full amount. In the event that you are over 30 days late with any payments HRA reserves the right to initiate court action.

The target letter fails to mention that assigned HRA Investigator has the authority to work out the details of the monthly payment plan with the claimant. Depending on the facts and circumstances of your particular case you might be able to present mitigating factors which could reduce your liability or cancel any liability.

The Division of Claims and Collections will only accept a personal check, a cashiers check, a certified check or a money order. Checks or money orders should be made payable to Human Resources Administration and mailed to the following address:

New York City Human Resources Administration
Division of Claims and Collections
P.O. Box 414312
Boston, MA 02241-4312

A recipient of a target letter from the Division of Claims and Collections must be careful how they proceed upon receipt of this letter. There is a value to money in hand today, rather then money possibly in the future. Further, it is possible that their investigation was limited to a certain time period and that as their investigation continues further fraud could be recovered. Our NYC medicaid fraud lawyers can help investigate and understand all components of this.

Installment Note Financial Maintenance Form

NYC Medicaid Fraud Lawyer

[vc_video link=”https://www.youtube.com/watch?v=et7x6CAxHK4″ align=”center”]

Download the 2013 NY Medicaid Income and Assets Levels. Each year the income and resources level are adjusted. Medicaid recipients can own a car, a home, and have personal property to be eligible. The issue with Medicaid fraud on the applicant side is the disclosure. Additionally, not only is the income and resources level for the applicants counted but the income and resources of any legally responsible adults. This is another area where the problem lies. Applicants are often confused as to what “resources” are for medicaid purposes. Under the Medicaid guidelines resources is cash or any assets that can easily be liquidated into cash. Generally this would be bank accounts, life insurance policies, stocks, bonds, mutual funds, promissory notes and real estate.

Family Health Plus Fraud

The NY Medicaid fraud lawyers at Spodek Law Group P.C. not only represent applicants for medicaid in fraud charges, civil and criminal prosecutions but our NYC medicaid fraud attorneys also represent individuals who are charged with defrauding Family Health Plus. Family Health Plus is a public health program for adults are between 19 and 64 years only and income is above the threshold for medicaid. Often, our NYC medicaid fraud lawyers see this as a possible fraud issue.

Child Health Plus Fraud

Children are under 19 years old, residents of NY State . Depending on what the families income and size is will depend on the premium they are required to pay for child health plus. The income is $9, $15, $30, $45, or $60 per child per month.

In addition to applicant fraud for Medicaid, Family Heath Plus and Child Health Plus applicants can commit frauds in other ways as well. Here are some ways our NYC medicaid fraud lawyers have seen in the past.

  • Intentionally lying on your medicaid application regarding your income or assets
  • Intentionally lying on your medicaid applications regarding your spouses income or assets
  • Failure to report any material change in you or your spouses income during the fiscal year
  • Obtaining prescription drugs via a valid medicaid card and then selling the drugs on the black market
  • Loaning your medicaid card to a third party for them to receives medical services
  • Illegally obtaining multiple medicaid cards, and using them for medical services
  • Forging or altering a prescription
  • Acting as runner on behalf of a clinic to obtain new medicaid patients

Provider Health Care Fraud

The NYC medicaid attorneys at Spodek Law Group P.C. also represent providers who are under investigation or being charged with medicaid fraud.

Billing for Services Not Rendered

A medical provider bills medicaid for services, treatment or procedure that was never done. This could be a doctors office billing for blood tests when no blood samples were actually draw. This could be a doctors office billing for x-rays when no x-rays were ever done. Dentists billing for dental fillings yet they were never done. Also, home health care is ripe with double billing. Our New York medicaid fraud lawyers can help with all of these types of fraud.

Double Billing

Double billing occurs when a provider bills medicaid for services rendered, but also bills the patient directly and/or a third party insurance company for the same services. This also occurs when (2) providers bill for the same treatment that was performed on a patient on a certain date.

Substitution of Generic Drugs

A patient pays a premium for the brand name drug and a pharmacist provides generic drugs instead.

Billing for Unnecessary Services

A medical provider will create fake symptoms and provide a fake diagnosis in order to bill medicaid for unnecessary lab tests.


This is when a medical provider exaggerates the medical service provided. For example, a dentist sees a patient for a 15 minute meeting to see the progress of a root canal but charges for an hourly consultation for pain and discomfort that the patient is suffering. The Dentist has improperly billed for unnecessary charges by upcoding the charge.


A medical provider may conspire with another provider to give a kickback for a referral. The kickback can be in the form of money, gift, products or a cross referral. Our NYC medicaid fraud lawyers have experience handling kickback cases.


This is when a medical provider breaks one medical event into separate components. This is done so that the medical provider can bill for unnecessary services. Our NY medicaid fraud law firm knows how to handle these cases.

Identify Theft

This is when third parties sell their medicaid billing number to medical providers in order for them to bill for services that were not rendered. Our NYC medicaid fraud attorneys understand how to handle these cases.

Medicaid Fraud Control Unit

The MFCU is a division of the Attorney Generals Criminal Division that investigates and prosecutes New York State medicaid fraud cases. The MFCU focuses their investigations on medicaid frauds by hospitals, pharmacies, doctors, nurses, dentists and nursing home. Another target of the MFCU is organized crime medical mills.

Civil Lawsuit for Medicaid Fraud – Our NYC Medicaid Fraud Lawyers Can Help

In the event that you receive a target letter from Human Resources Administration and you either object or disregard the letter and there is no evidence of criminal culpability then you may be sued civilly. New York City hires various law firms in New York to bring civil suits to recover payment. Generally these are collection lawyers. Generally recipients will receive a boilerplate letter stating the following:

We are the attorneys for The City of New York. According to our clients records you received Medicaid Assistance to which you are not entitled. Therefore you are indebted to our client in the amount set forth above.

If you believe that you have a legal defense with respect to the debt or any portion thereof kindly contact the undersigned at once. Unless you notify this office within 30 days after receiving this notice that you dispute the debt or any portion thereof, we will assume the debt to be valid. If you notify us in writing within 30 days that the debt or any portion of the debt is disputed we will obtain verification of the debt or a copy of the Judgement and mail it to you.

In the event that you don’t move to validate the debt and you don’t answer the letter and surrender yourself to their demands you will likely be the subject of a civil lawsuit. You will be served with a Summons and a Verified Complaint.

Our NYC medicaid fraud lawyers are always available to help answer any questions you may have. Based out of New York, our medicaid fraud attorneys understand how to win tough cases.

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