Medicaid fraud runs rampant throughout New York City. It is not familiar to just a specific group of people. Those who commit Medicaid fraud come from all walks of life. However, their status in society does not matter to the courts in New York City.
What is Medicaid Recipient Fraud?
Medicaid is a benefit awarded to low income, disabled and poor people. It is funded by state government via the federal government. Medicaid fraud involves providing false information to the government in an attempt to receive benefits.
Medicaid fraud does not just involve false information, but the omission of information as well. The different ways of committing Medicaid recipient fraud are as follows:
• Submitting an application (including recertification) with incorrect information
• Not disclosing your true income
• Not disclosing your spouse’s income or your household income
• Not disclosing income from a rental property
• Not disclosing income from your hobby
• Income reported does not correspond with your expenses
• Hiding information about your income or assets
• Reporting a false address (living outside of New York City)
• Selling your prescription medications paid for by Medicaid
• Filling counterfeit prescriptions
• Receiving benefits you are not entitled to
• Loaning your Medicaid card to someone else
• Owning multiple Medicaid cards
What Prompts an Investigation?
The investigation begins with you. Something about you or your actions triggers the Bureau of Fraud Investigations (BFI) in New York City to look at you more closely. BFI is tasked with investigating those individuals whose actions constitute Medicaid fraud. It falls under the umbrella of the Human Resources Administration (HRA). BFI is not a lightweight. This division is responsible for the prosecution of many Medicaid recipient fraud cases in New York City. And, now, you are on their radar. A new case has been opened. There are several reasons why you could have been flagged. Perhaps you were just simply reported to the HRA. Maybe your income tax return contains a different address. Perhaps there has been suspicious activity with your bank account. Whatever the reason, you can rest assured that the investigators have already done the required legwork. This is what they have been trained to do. Their years of experience range from 10 to 30 years or more. They are professionals who are adept at performing intensive investigations. Although the investigators are not law enforcement employees, they do have the same mindset as them. They know how to collect evidence. They know how to testify in court. These Medicaid fraud investigators should not be underestimated.
By the time you receive an interview letter from HRA, the investigators have already gathered the necessary evidence against you. They have already verified your income with your employer. They have your bank account information. They have copies of your deeds and mortgages. These people are serious.
The Interview Letter
Let’s be clear. This will not be an interview. This will be an interrogation. By the time you receive this letter from the HRA, all evidence has been gathered, and it has been determined that you are indeed a Medicaid fraudster. As they see it, this interview just gives you the opportunity to incriminate yourself. And, by doing so, you just give them more ammunition in their case against you.
Potential Penalties for Medicaid Recipient Fraud
Whether you go to jail or not is dependent upon your case. If HRA has a strong, solid case against you, then you could possibly be imprisoned. However, if your case is weak, then other arrangements could possibly be made. But, the bottom line is that you should not plead guilty if you did not commit Medicaid fraud.
Penalties for Medicaid recipient fraud run the gamut from restitution to severe prison sentences. Such penalties also include the following:
• Ineligibility for Medicaid benefits
• Civil judgment
• Property lien
• Wage garnishment
• Revocation or suspension of professional license
Medicaid recipient fraud in New York City is a serious offense. Actually, it is a felony. You could be charged with grand larceny or welfare fraud. And, if you plead guilty to either, then you will have a criminal record forever.
When you are faced with a Medicaid fraud charge, you should immediately hire an attorney who has experience in this field. You need someone who knows how to handle such a case. Someone who will tell you what your rights are in such a case. For example, you may not know that you are not required to speak with the HRA investigators. Let an attorney lead you to your best case scenario.