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Medicaid Fraud

Medicaid Fraud is a national problem.  Various city, state and federal officials act very aggressively when they think someone has lied on their application for Medicaid or NY Family Health Plus.  If you receive a letter (click here to see an example) asking you to meet with an investigator then it is time to call a Medicaid Fraud Lawyer.  This letter could be the beginning of a difficult and expensive process which if not handled properly early on could lead to a criminal prosecution.

Frequently Asked Questions:

Q:  Why have I received a letter from an investigator?

A:    Medicaid has two main rules:   You cannot make too much and you must live in the county or city that approved your application.   The chart below is the latest guidelines.   If the investigator suspects you made more than the minimum, then they retroactively can deny you benefits even going back six years.   You break the rules you; have committed Medicaid Fraud.

(View Chart Guidelines)

Q:  So how do they know how much you make?

A:   If you make more than the above guideline, then you will be investigated for earning too much. If the Medicaid Fraud Investigator asks for a lot of financial records, you can guess what they suspect.  For instance does you letter request you bring them:

  • Business bank book for the years under investigation. They will add up the yearly deposits and ask you why they are higher than your income.
  • Personal bank book for the years under investigation
  • Driver's license and car registrations: Ownership of late model cars show wealth.
  • Income tax documentation for the business for the years under investigation
  • Income tax documentation for your personal returns for the years under investigation
  • Recent pay-stubs
  • Utility bills: Can you afford these bills?
  • Cell phone bills
  • Mortgage: Can you afford to pay your mortgage?
  • Deed: How many homes do you own and where are they?

Q:  How can all this affect me?

A:   They are going to add up your bank deposits and your expenses to determine if they equal or exceed you stated income.  If there is evidence of under-reporting and do not have a really great and legal explanation you can be charged with fraud, grand larceny, and other serious crimes.  Now you can see why they would want you to come in and talk to them without a lawyer.  Your words can and will be used against you.  You can be charged with felony crimes that could send you to prison.  A criminal conviction will haunt you for the rest of your life.  This criminal conviction will come up every time you apply for a job, and if you are not a U.S. citizen, it could result in deportation.

Q:  What is an effective Medicaid Fraud defense?

A:   We will review your documents and bank statements ahead of time and can help you prepare for the interview and prevent unfair or improper questioning.  We are experienced Medicaid Fraud lawyers and have negotiated with these investigators to avoid or reduce the charges, fight for dismissal of the charges and avoid an embarrassing arrest.

Q: How much time do I have from receiving the letter?

A:   Since the government has sent you that letter, they are already preparing the case against you.  By the time you get the letter, the investigator has already gathered evidence against you, and they already suspect that you have done something wrong.  They are testing you to see if you will bring in altered documents.  Don't fall into that trap.  You need to start preparing your defense with a competent Medicaid Fraud Defense lawyer.  Do not try to handle this on your own.  You should contact an experienced Medicaid fraud attorney immediately, before you say anything to the investigator.  In many cases, a Medicaid fraud attorney can negotiate a settlement that will save you time, money, and potentially very serious civil and criminal consequences.


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