Medicaid Fraud Investigations
Medicaid Fraud Investigations

Medicaid insurance is a New York State sponsored health insurance program for individuals and families who meet certain income and asset requirements. Throughout New York City, there are enrollment agents who are set up in certain neighborhoods to assist applicants with the process. The problem is that the enrollment agents do not care if your application is accurate and don’t walk you through the application process.

Ultimately, you may find yourself in a position where you received a target letter from the Human Resources Administration asking you to come down for an office interview to discuss your eligibility. It is important to understand that this letter is a request, it’s not a Summons and Complaint, it’s not a Subpoena. This is not to say that it is not important. However, it is manageable.

The target letter will give you a good indication of what the investigation is about, and where it is going. Generally the letter will ask for the following:

  • New York State Drivers License
  • Business Bank Records For The Prior 3 Years
  • Business Credit Card Statements
  • Personal Back Records for the Prior 3 Years
  • Pay stubs
  • School Verification Letters
  • Retirement Asset Verification
  • Loan Documents
  • Birth Certificate
  • Marriage and/or Divorce documents

New York State Drivers License in Medicaid Investigations

Let’s walk through each one of these items and discuss how it could be useful in a medicaid fraud investigation. Medicaid is a County specific program. You and your family must reside in NY County to receive NY County benefits. If you live in Nassau County, then you can’t receive benefits in NY County. Ideally the drivers license will be one piece of identification that puts the claimant in one spot.

Business Bank Records in Medicaid Fraud Investigations

If you own you own business, you might set it up in a way so that your “salary” is a set number and you pay your personal bills out of the gross receipts. It may be also that you use your business bank account to carry large balances that you ultimately use for personal reasons.

Business Credit Card Statements in Medicaid Fraud Investigations

If you own a business, you might use your business credit cards which are paid out of your business back account to fund your personal life. For example, there might be expensive gifts, vacations, purchase at the supermarket on the bills. This is a good discovery tool in Medicaid Fraud Investigations.

Personal Bank Statements in Medicaid Fraud Investigations

If you don’t have a business account, then you personal bank statements will show the income coming and the expenses going out.

Pay-stubs in Medicaid Fraud Investigations

Pay stubs will show the gross and net amount of income one has. This will satisfy the income component of the medicaid eligibility. If there is income outside of your pay stubs this will have to be disclosed as well.

School Verification Letters in Medicaid Fraud Investigations

Generally, the school letters will serve a dual purpose. One they will provide residency for the children who are on Medicaid. This goes back to my point out residency. Second, they will detail whether the children are in private or public school.

Retirement Assets in Medicaid Fraud Investigations

A 401K, IRA or any other retirement account will provide details as to a claimants assets. This is the amount of cash resources they have at any given time. A savvy investigator might want to see when the income was contributed and the source of those funds as well.

Loan Documents in Medicaid Fraud Investigations

Loan documents come into play in medicaid fraud investigations in a few ways. One medicaid fraud investigations often target immigrant communities where people routinely lend money intra-family without formal loan documents. Further, family members pool money together to purchase real property with other.

Birth Certificates in Medicaid Fraud Investigations

The Medicaid Fraud Investigators will want to see the children of the household and more importantly the responsible legal parents of the child. The household income includes all members of the household.

Marriage and Divorce Documents in Medicaid Fraud Investigations

In certain instances the members of a household will not be married and believe this entitles to receive benefits based on just their income. However, the parents have a responsibility to care and support the children of the household regardless of the marriage.

Call us 24/7 to speak with a medicaid fraud lawyer at (212) 300-5196.