Civil Lawsuits –
If a Medicaid Fraud matter is not resolved at the administrative level, it will be sent out for civil litigation or criminal prosecution.
-The Bureau of Fraud needs to make a determination that a Medicaid recipient was not eligible for benefits, and therefore seek to collect the amount of money that the HRA paid out for Medicaid benefits for the recipient. This amount tends to be high because the monthly premiums add up over time.
-The HRA can send the case to the Law Department, which handles law suits on behalf of New York City.
-The Law Department can handle the case or send it to outside counsel which will sue the recipient in Supreme Court, Civil Term in one of the counties in New York City.
-Typically, before the law suit is started, the law firm will send a letter to the recipient stating that they are looking to collect for Medicaid benefits paid out on behalf of the recipient.
-If the matter is not settled, then the law firm will sue the recipient by filing a Summons and Complaint and starting the litigation.
-There will be an opportunity for the recipient, now the defendant in the law suit, to go to court and see the judge assigned to hear the matter.
-You may hire an attorney or you can represent yourself.
-The claim amount in court may include penalties, interest, and legal fees, and its likely to be much higher than the claim was at the administrative level.
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.