Medicaid Fraud

If you received a letter from Human Resources asking you to come for an interview regarding your Medicaid, you are being investigated for Medicaid Fraud. This is a crime that is potentially punishable by up to 15 years in prison and a felony on your permanent criminal record. To avoid these consequences, call us before your interview.

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It is important to be represented by an attorney in all cases. Medicaid fraud has become a political issue during the recent elections and many people have recently been investigated since. You need a lawyer who knows exactly what to do when a client is accused of medicaid fraud. To consult our attorneys, call (646) 350-0601.


Medicaid Fraud Information

The Health Department’s Office of Medicaid Management reviews recipient utilization and investigates other charges of fraudulent behavior in order to take action against them. Some types of recipient fraud may be referred to government authorities other than the Health Department, such as Criminal Court.


Medicaid Recipient Fraud

A Medicaid recipient may be medicaid fraud investigation as well as criminal charges due to any of the following:

  • Stating false facts on the application to receive medicaid despite being ineligible;
  • Loaning Medicaid to another person;
  • Forging or altering a prescription or fiscal order;
  • Using multiple Medicaid cards;
  • Intentionally receiving duplicative, excessive, contraindicated or conflicting health care services or supplies; and
  • Re-selling items provided by the Medicaid program.


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 located at 250 Church Street, 3rd 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 at 250 Church Street,3rd Floor to discuss this matter. The target fails to tell you that if during 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. Either way, whatever you say and do – will be held against you in court. The ideal situation for the HRA investigators is that you come down to the scheduled meeting, disclose everything and then they demand an inordinate amount of money from you and you are left with few options. The letter itself itself will give you a good idea of the type of evidence that they already have against you.



The letter will ask for the following documents when you come down for their meeting.

  • 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
  • Mortgage
  • Deed
  • Letter certifying where your children attend school

Legal Fees: $2,750



Medicaid/Medicare Provider (Medical Office) Fraud

* Billing for services that were not provided, e.g., a chest x-ray that was not taken.
* Duplicate billing which occurs when a provider bills Medicaid and also bills private insurance and/or the recipient.
* Requiring the recipient to return to the office for more visits when another appointment is not necessary.
* Taking unnecessary x-rays, blood work, etc.
* Upcoding, e.g., providing a simple office visit and billing for a comprehensive visit.
* Having an unlicensed person perform services that only a licensed professional should render, and bills as if the professional provided the service.
* Billing for more time than actually provided, i.e., counseling, anesthesia, etc.
* Billing for an office visit when there was none, or adding additional family members’ names to bills.
* Accepting payment from another provider, including sharing in the reimbursement paid by the Medicaid program, as a result of referring a patient to the other provider.

Legal Fees: $2,750-$8,500


Why Retain An Attorney?

The person deposing you can get you to confess to things you haven’t committed. Your meeting with the investigator will be a very stressful event with an empowered government employee accusing you of serious offenses. You need to make sure that you are prepared before the meeting, and that you have competent defense that will protect you from unfair and improper questioning.

Therefore, if you’ve received a notice accusing you of medicaid or medicare fraud, it is important to immediately retain a competent attorney who has experience defending medicaid or medicare fraud cases. A competent attorney can often save you more money than his legal fees by negotiating with the government. He would also work to prevent you from getting arrested and convicted of a crime.

Medicaid and medicare fraud could be a felony crime. Such conviction can haunt you for the rest of your life, for example when you search for a job. It can also potentially result in a deportation from the United States for anyone who’s not a citizen. Therefore, before you are deposed by by the investigator, you must be carefully prepared by your attorney who must explain what questions you should anticipate.


Why Retain The Storobin Law Firm?

1. We are experienced in defending people in this particular area of law. You do not want to hire an attorney who’s even more scared than you are and has never defended people accused of Medicaid fraud.

2. We charge a flat fee you can afford.

3. All the legal work is performed by a lawyer, not an uncertified paralegal.

4. The right lawyer can often save you more money than his legal fees.

5. We offer a free consultation. To schedule a consultation, call (646) 350-0601.