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Agent Visits

Investigators from the HRA are required to do field visits for each case they are assigned. In fact, investigators are often out of the office because they are out conducting field visits. They usually travel in groups of two investigators when out in the field. For each field visit they do, they fill out a report on their findings, which becomes part of the case file.

Places of Interest – Fraud Investigator Visits

HOME – The investigators will go to the address that you provided to determine whether you really live there. They often make several trips to a recipient’s home. They want to see who actually lives there and they usually try to speak to someone at the residence. They often speak with neighbors, who are more often than not, happy to chat. They take photos of people coming in and out of the home for their file. They come to the home at different times of day to see who is home at any given time. They have been known to observe people coming and going at different times of the day and can come back several times in order to establish residence.

WORK – If you list a place of employment on your application, the fraud investigators will often come to your job to see whether you really work there. They want to see if the business or organization is real and what kind of work they do. Once they establish that, they want to verify from the employer what a recipient’s job title and earnings are. They often will send payroll inquiry forms to your employer. If you work at a small place, then this often causes embarrassment for the recipient. The investigators are usually polite and professional but their presence certainly makes everyone uneasy.

CHILDREN’S SCHOOL – If you have children, the HRA fraud investigator will verify where your children are enrolled in school. This often goes hand in hand with residence, with the idea being that typically children go to school near where they live (or at least in the same county). For example, if your children attend school in Nassau county, there is a presumption that they live in Nassau County as well.

HOME OF ESTRANGED MOTHER/FATHER OF CHILDREN – The HRA fraud investigators will do surveillance on the other parent of any children that recipients have. They will send payroll inquiry forms to their employers, seek out where they live and whether they are listed as contacts at the children’s school. They will follow couples who are “estranged” to see whether they are really living together or apart.

THINGS INVESTIGATORS LOOK FOR WHEN THEY DO FIELD VISITS
-Typically an HRA fraud investigator will want to speak to anyone that they can speak to. This includes anyone answering the door, neighbors, supervisors at work.
-When they do home visits, they want to see what the home looks like. Does the home make sense based on what the recipient provided on the application.
-They look for cars in driveways, and pull registrations to see who the car is registered to in order to see if that car owner lives at the address
-They look for makes/model of cars to determine whether it makes sense based on the recipient’s application. For example, a recipient who has a luxury car in the driveway will raise a flag with an investigator and will trigger the investigator to make further inquiries. Unless the luxury car has an explanation that makes sense, it can help build a case for fraud.

WHAT TO DO IF YOU ARE FACED WITH AN INVESTIGATOR CONDUCTING A FIELD VISIT
-It’s always best to be polite but to say as little as possible. It’s never a good idea to lie to the investigator because it shows bad faith and helps them build a case alleging fraud and the intent to commit fraud.
-Its perfectly acceptable to decline to make a statement. The investigator can’t force you to speak if you do not want to.
-It’s NEVER a good idea to lie about your identity. They likely have photos of you and know what you look like.
-It’s a good idea to ask the investigator for their name and ask for their card if they have one. They are supposed to tell you their names, they do not operate in secret.
-Any act of hostility or violence will likely hurt your case. As much as their visit may infuriate you, its best to remain calm and avoid any direct conflicts.

Questions? Contact us today.

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.

(212) 300-5196 or info@spodeklawgroup.com