1. The target letter is merely a request for a meeting. It is not a subpoena, a court order from a Judge, or a letter stating that a hearing is taking place. It is merely a request for further information.
2. There are numerous reasons why a medicaid recipient might receive a medicaid fraud target letter. It does not necessarily mean that have committed a crime and/or done anything wrong.
3. In the event that you have done something criminal, it does not necessarily mean that they want to prosecute you, or the DA’s office wants to take the case forward. Keep in mind that the burden in criminal court is proof beyond a reasonable doubt. The treat of criminal charges is more often a scare tactic of investigators and defense lawyers then it is a reality.
4. The medicaid rules and regulations are complex and change each year. Often times a through calculation will show that our clients were entitled to benefits for a period of the claim period.
5. The assigned investigator often has a limit on their ability to negotiate claims, however this doesn’t not mean that you can’t present mitigating evidence to a supervisor to work out out more favorable resolution.
6. There is a cost of doing business. In the event that HRA wants to refer your case out for civil litigation. They must hire a collection law firm that will be entitled to take a percentage of the money that they collect. The firm might have a hybrid retainer where they take an hourly rate as well. In addition there are court costs and associated fees. This brings down HRA’s net recovery. The more money they have to spend to collect, the less they ultimately obtain.
7. Money today is worth more then the potential for money tomorrow. In the event you are sued, all that will be recovered is a judgement. A judgement often times is worth as much as the paper it is on.
8. Speculation and Conjecture is not the same as definitive proof. Just because an investigator believes that you falsified information, and/or omitted information, does not mean it’s definitive proof. Use this to your advantage in settlement negotiations.
9. You have the right for a lawyer at every step of the investigation.
A lawyer who not only handles medicaid fraud cases with the HRA but also in civil and criminal courts. A lawyer who can easily navigate the medicaid eligibility requirements and fight for the lowest possible settlement.
10. If you are currently on Medicaid, yet under investigation your benefits can be stopped just because your investigation. Don’t let them pressure you to settle.
If you are the target of a medicaid fraud investigation, call our office 24/7 for a free consultation. We have offices in Brooklyn, Manhattan and Queens.