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Medicaid Fraud Investigations in New York City

10th November 2008
By Author Unknown in Legal
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Health care coverage in New York these days costs an arm and a leg. Think you can have a break but applying for Medicaid? That may be so - if you financially qualify. On the other hand, if you don't, think twice before applying because you may be investigated for fraud sooner than you think.

If you have applied for Medicaid in the State of New York, particularly in New York City, and misrepresented facts regarding your income and assets on your application, you may become another target of relentless and massive hunt for fraudsters. The new initiative that started a few years ago across the state has netted thousands of Medicaid recipients who had received Medicaid fraudulently. Numerous people were recently contacted by New York City Bureau of Fraud Investigation and other agencies that routinely investigate New York Medicaid fraud.

As a benefit recipient, you are obligated not only to provide truthful disclosure of your financial status when you apply for Medicaid, but also inform the program of any changes in your income. Many Medicaid fraud cases that have come to my office involved individual recipients who for this or another reason concealed their income and assets. Many had disclosed a significantly lower income then it really was and many used a fictitious address or concealed assets. Obviously, most were ineligible to receive Medicaid. Less known is that the duty to update financial eligibility information applies immediately upon the change occurs. If you are eligible to receive Medicaid but become ineligible before your next recertification, you must notify the agency or you will be committing fraud.

In many cases, the investigation is conducted and completed without your knowledge. At some point you will receive a letter from the Bureau of Fraud Investigations asking you to come to their office for an "interview" along with certain documentation. By that time the investigation is practically completed. If you receive such letter, you should seek legal advice immediately before discussing anything with investigators. If you go to the interview and voluntarily submit requested information, you may be confessing to having committed a crime and it will be used against you in case the matter is referred to the local District Attorney's Office for criminal prosecution.

At the investigative stage of the case, the most optimal resolution of is avoiding prosecution and your chances of a favorable outcome increase dramatically if you deal with the investigative agency early and in the right way, though your attorney.


Joseph Potashnik is a criminal defense attorney who defends individuals facing criminal charges in New York City and New Jersey. You can visit his websites at for NY and for NJ.

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