How to Survive a Medicaid Fraud Investigation

Receiving a Medicaid fraud letter can be intimidating. Alone, the average person does not possess adequate knowledge to understand why they are being interviewed, and where their Medicaid fraud investigation may lead. Without proper guidance from an experienced professional, they may end up tarnishing their personal record forever because they decided to tackle Medicaid fraud investigators on their own.

How to Survive Medicaid fraud Investigation

How Will I Know If I Am Accused of Medicaid Fraud?

First of all, how do people get accused of Medicaid fraud? The Human Resources Administration (HRA) uses computer analytics to match Medicaid recipients with databases containing information about their assets, employment, education, and finances. If they discover inconsistencies between the databases and the information you reported on your Medicaid application or recertification, they will suspect you of Medicaid fraud. At this point, they may conduct field investigations and reach out to your employers, past or present, without your knowledge in order to gather information and construct a case against you. Then, the HRA Bureau of Fraud Investigation (BFI) will send you a letter requesting you to come in for an interview with the investigators. The purpose of this interview, regardless of what investigators may tell you, is to prove that you are guilty of Medicaid fraud by getting you to hand over sensitive information, such as your tax records, to the investigators.

Fact or Fiction: Does Bringing An Attorney to the Interview Convey Guilt?

At this stage, it may be tempting to go to the interview alone in order to save money on an attorney or prevent the investigators from thinking you are guilty. Contrary to popular belief, bringing a lawyer to the interview is not evidence of neither guilt nor innocence. A Medicaid fraud investigation is a criminal investigation, and bringing a lawyer to your interview does not affect the investigators’ opinion of you. It shows that you are prepared to defend your interests. If you go alone and comply with the investigators’ requests, you are essentially confirming all of their suspicions of you. You are escalating your case and giving the investigators a chance to refer it for criminal prosecution. Never go to the interview alone to avoid incriminating yourself and undermining your case. Remember that any information you disclose can and will be used against you in court.

As a Medicaid fraud investigation target, you have the right to consult with an attorney before your interview. An experienced Medicaid fraud attorney will review your records with you, and gather necessary documents and evidence to protect you and negotiate with the investigators on your behalf if needed. Your attorney acts as a buffer between you and the investigators. You are always allowed to consult your attorney before answering any of the investigators’ questions and handing over any documents. A qualified attorney will know which questions you are not required to answer and which documents you are not required to hand over. Your attorney will try to convince the investigators of your innocence and settle for a lower penalty or drop the case altogether instead of referring it for further criminal proceedings.

Medicaid Fraud Is A Serious Crime

If you show up to the interview by yourself and comply with the investigators’ requests, you can not depend on your lawyer to fix your mistakes later on. In the event that your case becomes a  criminal prosecution, it will become much harder to defend. If convicted of Medicaid fraud, you may face massive administrative and civil penalties such as fines, restitution, imprisonment, and a permanent criminal record. Needless to say, Medicaid fraud is not a matter to be taken lightly. That being said, it is also not a dead-end street, and with the supervision of a qualified Medicaid fraud attorney, you may be able to alleviate the financial and emotional burdens of the investigation.