An investigation from the Human Resources Administration in New York starts out with the receipt of a target letter sent by first class mail. It is not uncommon for the recipient of the letter to disregard the letter. This is often a very bad choice. The problem with these letters is is hard to decipher who the letter actually comes from. It can state that it is from the Human Resources Administration, Department of Social Services yet it will also be on letterhead that states it is from Investigation Revenue and Enforcement Administration, Bureau of Fraud Investigation.To better understand how to defend yourself from a fraud investigation, it is helpful to understand who the players are. Let’s start with the Human Resources Administration. This is the umbrella organization that provides benefits to over 3 million New Yorkers. The public benefits that people get are temporary cash assistance, food stamps, medicaid, home care, child care, child support enforcement, domestic violence, HIV support along with other programs. This is the largest social services agency in the United States. The Human Resources Administration administers over $30 billion in annual benefits.
Now, the Bureau of Fraud Investigation is a separate entity that’s sole purpose is to investigate fraud. The investigators who work there do this full time. There are two locations in which the investigators work out of in Manhattan:
Bureau of Fraud Investigation
151 W. Broadway, 7th Floor New York, NY 10013
Bureau of Fraud Investigation
250 Church Street, 3rd Floor New York, NY 10007
Next, the Investigation Revenue and Enforcement Administration. This is the investigative entity for the largest social services agency in the United States. The fraud investigators take their jobs seriously and have a arsenal of investigative techniques and options to help them sort out medicaid and welfare fraud.
In fact the Investigative Revenue and Enforcement Administration are known world wise for two breakthroughs that have brought them acclaim. First, is the use of data matches and analytic to support their fieldwork and a focus on the initial applications to avoid having any fraudulent enrollment in any of their social service programs. It’s a two fold process, one is detecting fraud on the onset prior to the applicant receiving any benefits. Second, it is the ongoing detecting of false representations on the applicants medicaid applications and renewal applications or recertifications.
The letter you received is what we refer to as a “target letter” from a fraud investigator with the Bureau of Fraud Investigation who is investigating whether you fraudulently obtained medicaid benefits or some other type of public assistance. Each year Investigators from the Bureau of Fraud Investigation send out countless target letters. Over the years I have seen certain ethnic communities get targeted for various reasons. Often times when you receive a letter, your friends and business associates will as well.
The investigation into your finances at the time of your initial application and any renewal applications has long come and went. By the time the investigation is underway, they have built a case against you. The way I like to explain the medicaid fraud investigation process is like a scale from white to black. Whit is you are 100% eligible for benefits and you have disclosed your income and assets in your initial application and the renewal applications. Grey is when you failed to update the application that you moved to Nassau County and/or you inherited some property but failed to update Human Resources Administration. Black is when you outright do not qualify and you own various pieces of property plus have income way over the thresholds. Depending on where you fall on the scale will depend on your options. Ideally your attorney will be able to gage from experience where you fall and what the best strategy is to obtain the following things:
Avoid criminal charges
Avoid civil prosecution
Reduce the claim amount to the lowest possible number
The Bureau of Fraud Investigators not only do data related investigate but they actually do field work as well. This can include the following:
Pictures of your business
Pictures of your home
Interviews with people you know
Verification of employment
Verification of school enrollment
Obviously, the starting point for the investigators is the application. What numbers did you use for the application? Were they accurate? Are there other documents out there that will contradict the numbers on the application? What about the re-certifications? Did your family size change? Did you jobs change? Did you inherit money? Did you inherit property? Are all of the sources of your income listed?
Over the years there seems to be a four major areas in which the investigators focus on:
Income for all of the years in question
Residency of the applicants. Remember Medicaid is a residency based program.
Employer Offered Health Insurance
To properly defend an individual from a medicaid fraud investigation, it takes time and dedication to understanding the applicants family structure, and finances at the time of the application and any renewal applications. If you have any questions, or would like to schedule a free consultation with a medicaid fraud lawyer call our offices 24/7 at (212) 300-5196.
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.