What is Medicaid Fraud?
Medicaid fraud is billing for services not provided, performing unnecessary tests, unnecessary referrals, and charging separately for services usually offered at a packaged rate. Anyone who received Medicaid illegally is subject to investigation. If you received a letter from NYC HRA stating that your eligibility for medical health insurance is under review, you may actually be investigated for Medicaid fraud.
Get prompt, professional help from the highest rated Criminal New York medicaid fraud attorney Inna Fershteyn, Esq. Call (718) 333-2394, and immediately experience the difference in knowledge, service and attention your case will receive. Fees are affordable; you will work with the Principal attorney who has over 20 years of experience; and, you will work with the best rated attorney in NY.
Why is my Medicaid Fraud Case Flagged?
Most Medicaid fraud cases in NYC are flagged because of the recipients' failure to disclose the full household income on his or her application/recertification(s) or failure to update the agency about an increase in income. Many people who receive Medicaid are investigated for fraud because they didn’t disclose:
- their real earned income;
- the income of people who live with them or whom they have children with; or
- their unearned income (rental income, gifts, support, gains from stocks, interests, etc).
If you are the subject of a NYC medicaid fraud investigation, you can face a number of legal consequences including criminal charges, fines, and restitution payments. Your immigration status and your employment can be jeopardized. If you received the HRA investigations letter, call an HRA fraud investigation attorney at the Law Office of Inna Fershteyn right away before speaking with investigators. We may be able to obtain an administrative resolution for the case before it is referred to the District Attorney's office.
NY Medicaid Fraud Investigation FAQ
1. What should I do if I received a call from the District Attorney's Office? What do I do if I end up having criminal charges filed against me for Medicaid Fraud by Manhattan or Brooklyn DA's office?
If you were already contacted by the investigator from Brooklyn or Manhattan DA’s office or if you were advised by your investigator that your medicaid fraud case will be forwarded to District Attorney's office for further investigation, you have to hire best NY best criminal medicaid fraud attorney immediately. Since the case is now in criminal investigation, you have to have an attorney representing you. Top medicaid criminal defense attorney can negotiate an offer with district attorney's office to avoid incarceration and reduce felony conviction for medicaid fraud to a misdemeanor or even a violation charge and office to minimize the charges and possible restitution. Hire an experienced Medicaid Fraud Attorney who will contact the DA’s office on your behalf and will negotiate settlement in your favor. Contact our office at 718-333-2394 and we may be able to STOP THE ARREST. We will also explain the legal process to you, discuss potential outcomes and discuss your various options every step of the way.
Lately we have seen an increasing number of clients who are facing criminal charges as a result of their Medicaid Fraud Investigation. Some cases were held in the DA’s office for years and some were just transferred to the District Attorney’s Office from the HRA Bureau of Fraud Investigations.
If your Medicaid Fraud Investigation ended up with criminal charges against you, you will be arrested and held in jail until you see the Judge, which may take twenty-four hours or longer. Criminal charges against you may include felony, grand larceny, possession of stolen property and others depending on the severity of the offense. We have seen the criminal complaints including the following charges:
P.L. 155.35 (1) – Grand Larceny of the 3rd Degree (D Felony)
P.L. 165.50 – Criminal Possession of Stolen Property in the 3rd Degree (D Felony)
P.L. 158.15 – Welfare Fraud in the 3rd Degree (D Felony)
P.L. 175.35 (1) – Offering a False Instrument for Filing in the 1st Degree (E Felony)
P.L. 155.25 – Petit Larceny (A Misdemeanor)
P.L. 165.40 – CPSP 5th Degree (A Misdemeanor)
P.L. 175.30 – Offering a False Instrument for Filing in the 2nd Degree (A Misdemeanor)
- What is the difference between Medicaid and Family Health Plus?
Medicaid is a program involving federal government and every state individually to provide health insurance to people with low income.
Family Health Plus – is the program for people between the ages 19 and 64 who are not eligible for Medicaid and have no other means to obtain health insurance.
Child Health Plus - is a subsidized program that will provide health coverage for children up to 18 years old.
- Why is my case being flagged by HRA?
The most common reasons for any case to become a target for Medicaid Fraud Investigation are:
- Misrepresentation of household income on the Medicaid application.
- Misrepresentation of family composition.
- Failure to provide information about any changes in residential address, household income or household members.
- My application was completed by an enrollment agent and he/she told me it is ok to lie. Am I still liable?
The recipient is always responsible for the information provided on Medicaid or Family Health Plus applications. On the application you signed your name under penalty of perjury and confirmed all information provided is true. The enrollment agent has no liability for incorrect information provided on your application.
- I received a letter from HRA Medicaid fraud investigation. What does it mean?
When you receive a letter from HRA, in most cases, it means that there is an open investigation case going on and that investigator believes that you are or, at some point, were not eligible for Medicaid/Family Health Plus insurance.
6. I received a letter from NY Food Stamp HRA investigation regarding my SNAP Benefits, what does it mean and what should I do?
The letter could come from 375 Pearl Street, 22nd Floor, NY NY 10038 and will ask you to come in and prove that your SNAP benefits application listed your correct address, correct income, you didn't make any cash bank deposits, you don't own any properties aside from personal residence and you listed ALL the members of your household on your application, including your boyfriends and girlfriends, even if you are not legally married and even if they are not the parents of your kids. If you fail to respond to HRA Medicaid fraud investigation letter, your case will be immediately forwarded to Brooklyn or Manhattan or Staten Island District Attorney's office for further investigation, charges and possible arrest. Do not go to the HRA SNAP benefits investigation office without your attorney as everything that you say will be used against you. If you hire NY medicaid fraud attorney he will appear in HRA SNAP office on your behalf and your presence will not be required.
7. What should I do after I receive the letter from HRA Medicaid Fraud investigation?
If your letter says that you have a scheduled date to meet with the HRA investigator, do not plan on going there by yourself. In most cases, when the investigator is asking you to come in person he or she already collected evidence proving that you were not eligible for Medicaid or Family Health Plus benefits. Most investigators have completed the "field visit" and have visited the place where you said you lived on your application, spoke to your neighbors and took pictures of you shopping in the supermarket. If you filed with an incorrect address or you did not list all the people residing in your household or you stated that you are separated from your husband and in fact you live together, your case will be immediately forwarded for criminal prosecution. If you appear on the interview by yourself or hire incompetent medicaid fraud attorney to representyou, you will be putting yourself in grave danger by answering investigator’s questions, directly and disclosing information which may not have been available to the investigator before. It is extremely important that you hire a criminal defense attorney with many years of experience representing clients in front of medicaid fraud investigation office and in front of the DA's office so you can avoid appearing at the fraud interview altogether.
8. What are my rights if I am being investigated by HRA?
You have a right to legal representation and can bring an attorney to the initial meeting with the investigator, or have a consultation with a qualified Medicaid Fraud attorney prior to such meeting. You have a right not to answer any questions at the meeting with the investigator and if there is any potential for criminal prosecution you can, pursuant to 5th Amendment, remain silent. But best is to hire an experienced fraud attorney with many good reviews ahead of time and avoid personal appearance at the medicaid fraud interview altogether.
9. How will the investigation be conducted by the HRA?
Investigators at HRA office have access to many different databases, including DMV, NYS Real Estate, NYS Division of Corporations and many more. Also, investigators can personally visit your house and speak to your neighbors to verify your residency address and will send a request to your employer to find out your actual earned income. Investigators will wait for you outside your residence and take pictures of your cars parked in the driveway, see who takes your kids to school in the morning and take pictures of you doing grocery shopping. If you live in NJ but filed for medicaid in NY, investigators will take pictures of you shopping in NJ to prove that you used your SNAP benefits in a different state. They will speak to your child's school to see where your kids reside and where they go to school.
10. What are the consequences of Medicaid/Family Health Plus investigations?
The consequences may vary depending on the outcome of the investigation. If the case has no criminal allegations, it may end up in full restitution of premiums paid on yours and your family during the time that you were ineligible for the benefits. Additional monetary penalties, including interest may be imposed on you after the investigation is complete. If the case ends up in civil court the judgement can be attached against your assets and a lien can be placed on your real estate and personal property, including garnishments of your wages. In the worst case scenario, if criminal charges are brought against you, you can end up with a prison sentence, lose your professional license or be deported if you do not are not a citizen. You may end up with felony conviction and probation as well as large restitution. Hiring the best criminal defense attorney specializing in medicaid fraud is the key for winning the medicaid fraud investigation case.
11. Will I have an option to settle my case with the investigator?
The earlier you start dealing with this matter the greater chance you have to negotiate a settlement. Seek professional help from an experienced Medicaid fraud attorney who knows when the best time to ask for a settlement is and how to negotiate medicaid settlement amount down.
12. Is it better to meet with investigator first and then seek legal help if the meeting did not go well?
No. Again, any information you provide to the investigator, including any documents that they request from you in the letter will be used against you during the investigation. Remember that when scheduling an appointment with you, investigator already collected pertinent information including photographs of the cars you and your spouse drive, your bank account statements, your pay checks from your employer as well as interviews with your neighbors.
13. What are the goals of a Medicaid fraud investigator?
There are always 2 investigators at each medicaid fraud meeting which can take place at either 243 Schermerhorn Street, 5th floor in Brooklyn, NY or at 375 Pearl Street, 22nd Floor NY NY. Initially investigators begin with review of the applications for the welfare programs that HRA administers, including public assistance, food stamps, Medicaid and others. Investigator's goal is to determine whether the applicants were eligible for the benefits they applied for. During the fraud interview the goal of the fraud investigators is catch you in a lie and to prove that you were ineligible for benefits. A SNAP and Medicaid benefits fraud attorney can assist you in preparation for this investigation interview and to attend it on your behalf.
In cases where criminal charges are being brought, Medicaid fraud investigators will collaborate with the District Attorney's office to collect evidence and work on trial strategy.
14. What other agencies can conduct Medicaid fraud investigation?
- Bureau of Fraud Investigation
- Investigation, Revenue and Enforcement Administration (IREA)
- Office of Medicaid Provider Fraud and Abuse Investigation
- New York State Attorney General’s Office
- Medicaid Fraud Control Unit
- New York State Office of the Welfare Inspector General
- Brooklyn, Manhattan, Staten Island and The Bronx District Attorney’s Offices
- Office of Inspector General, U.S. Department of Health and Human Services
- Federal Bureau of Investigation
15. What is the Bureau of Fraud Investigation (BFI)?
The Bureau of Fraud Investigation (BFI) located at 151 W Broadway, New York, NY and deals with investigations on the recipient side, both of individuals and organized groups, who are suspected of committing Medicaid fraud. BFI investigations may result in Administrative Disqualification Hearings, lawsuits to recover money, or referrals to the District Attorney for criminal prosecution.
16. What is the Investigation, Revenue and Enforcement Administration (IREA)?
The Investigation, Revenue and Enforcement Administration (IREA) located at 375 Pearl Street, 22nd Floor, New York, NY. There are three subdivisions of this agency. The three divisions are: the Bureau of Fraud Investigation, the Office of Medicaid Provider Fraud and Abuse Investigation, and the Office of Revenue and Administration.
17. What is the Office of Medicaid Provider Fraud and Abuse Investigation?
This subdivision of IREA office deals with Medicaid providers and conducts investigations and audits of suspects of fraud, waste, or abuse of government healthcare
18. What is the Medicaid Fraud Control Unit (MFCU)?
The Medicaid Fraud Control Unit (MFCU) is a large unit which investigates and prosecutes not only Medicaid fraud but also other healthcare crimes in New York State. This unit works within the New York State Attorney General’s office. The MFCU also prosecutes cases involving fraudulent billing practices by physicians, pharmacists, and other healthcare providers. Offices of MFCU are located at several regions, including Albany, Buffalo, Long Island, New York City, Rochester, Syracuse, and Westchester-Rockland.
19. What is an Administrative Disqualification Hearing?
If your case was not qualified as a criminal offense, the investigator may refer your case to the Office of Administrative Hearings (“OATH”) at the New York State Department of Social Services for an administrative disqualification hearing. During such hearing they will attempt to ban you from receiving benefits for a period of time that will be determined during the hearing.
Recent Closed Cases:
Client was accused of Insurance kick-backs and defrauding medicaid in the amount over $1,000,000. The charges against the client were :
- Grand larceny in the first degree (Penal Law 155.42)
- Commercial Bribe receiving in the first degree (penal law 180.08)
- Kickbacks (Social Services Law 366-d(2)
Client was facing up to 25 years in prison.
After working with Manhattan DA's office and special investigation unit, attorney Inna Fershteyn was able to reduce the charge to the misdemeanor violation.
Client was accused of Medicaid Fraud - not reporting income from his job and not reporting all the members of the household and defrauding medicaid in the amount of over $60,000. Client was facing criminal charges. Attorney Inna Fershteyn was able to negotiate a settlement on the case with monthly payments of $714 and no criminal charges.
Client was investigated for SNAP Benefits (Food Stamp) Fraud. Client was accused of making cash bank deposits while receiving SNAP benefits and not disclosing ownership of various entities. Client was facing criminal prosecution. The claim against the client was $12,000. It was settled by attorney Inna Fershteyn for $9,000 and no criminal prosecution.
Client was accused of Medicaid Fraud and not reporting her income. Client was a recent college graduate who started working for $75,000 and did not close her medicaid case. Client was facing a fine of $8,400. Attorney Inna Fershteyn closed the case with NO PAYMENT due from the client and proved that client was eligible for medicaid and did not owe any payment back.
The Client with a Medicaid Fraud Case was accused of defrauding the US Government out of hundreds of thousands of dollars. When he came to us he was facing not only paying back the money was accused of defrauding, but also huge fines and interest. Even worse, when he came to us, the case was on the brink of having the agency refer this matter to the US Attorney’s Office for prosecution in the Southern District of NY. Once Preet Bharara and his team got this referral more legal fees, fines, and jail time was in play, not to mention a permanent conviction as a felon. As a consequence, our first order of business was to put the brakes on the criminal referral, which we were successful in doing despite the fact that the evidence tended to suggest that the agency’s allegations were correct. We were also successful in undertaking very difficult negotiations to (1) get the fines waived, (2) get the interest waived, and (3) have our client only pay back a fraction of what he was alleged to have defrauded. The case was Settled for a fraction of the amount due and the entire record of the fraud investigation was sealed.
The Client and her husband were accused of Medicaid Fraud in the amount of over $90,000 with charges of P.L. 158.15 – Welfare Fraud in the 3rd Degree (D Felony) P.L. 155.35 ,Grand Larceny of the 3rd Degree (D Felony), P.L. 165.50 – Criminal Possession of Stolen Property in the 3rd Degree (D Felony) and P.L. 175.35 (1) – Offering a False Instrument for Filing in the 1st Degree (E Felony) charges against them. Prior attorney failed to settle their case with fraud investigation office and it ended up with Manhattan DA's office. Our law office was able to secure a proffer session with the DA's office during which time we were able to negotiate a misdemeanor conviction for only one spouse P.L. 165.40 – CPSP 5th Degree (A Misdemeanor) reduced restitution in the amount of $40,000 and a "walk through" arrest and sentencing on the same day.
At the Law Office of Inna Fershteyn and Associates, P.C. we provide immediate representation for all Medicaid Fraud Investigation cases to avoid criminal prosecution and explain what you should do if you are targeted by the Medicaid Fraud Investigation. With over 200 Five Star Reviews attorney Inna Fershteyn is the leading NY medicaid fraud defense attorney who helped thousands of clients avoid criminal prosecution and successfully settle medicaid fraud investigation case against them.
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MEDICAID FRAUD TESTIMONIALS
"Inna Fershteyn is a wonderful, smart, experienced and amazing person. She closed my Medicaid fraud case in less than 2 weeks and she got me the best settlement. She is really a people’s person- you feel like you can talk to her and she is very down to earth and approachable. All investigators in HRA office love her as well as she treats everybody with respect. I feel like Inna was sent to us by higher power she let me sleep at night." - Rafaela N.
"Inna did a great job closing my HRA case with a “0”. She was very professional and my case was closed in 2 months. She is the best Medicaid fraud attorney!" - Chee Y.
"I found Inna Fershteyn’s law office by reviews and was not disappointed. She was really very down to earth and explained everting in great details. She closed my case very quickly and I can’t not say enough good things about her." - Arkadiy M.
SNAP Fraud Investigation Appointments
250 Church Street
New York, NY 10013
Medicaid HRA Fraud
151 West Broadway 7th floor
New York, NY 10013
Medicaid HRA fraud
243 Schermerhorn St, 5th floor
Brooklyn, NY 11201