Generally, a criminal prosecution for Medicaid Fraud will following this path. Initially a target or a call letter will be mailed out from the Human Resources Administration requesting an initial interview. The client will either attend that interview and incriminate themselves or disregard the letter altogether. Either way the next step will be a call from the detective squad with the District Attorney’s office in the county in which the prosecution will occur. The detective will let them know that arrangements need to be made for them to surrender for criminal prosecution.
Criminal Trial for Medicaid Fraud in New York City
In a medicaid fraud trial the issue will generally be whether the applicant misrepresented her employment status and income when she applied to the NYC Human Resources Administration for food stamp benefits, temporary assistance, and medical assistance. Often times the applicant will put on the application that they were unemployed or had no income or resources. The District Attorney’s office will need to establish that the recipient of benefits is the defendant, and that they improperly obtained the benefits.
An investigator from Human Resources Administration will testify that an recipient of medicaid benefits with the same name, social security number, and home address received benefits as the individual who received salary form her job or had resources. The investigator will testify as how the welfare benefits are administrated, specifically how you initially apply and then certify periodically to notify HRA of any change in status. This re-certification can occur over the phone, or in person. In any event, the initial notes are handwritten and eventually entered into the HRA computer program. The re-certifications are then completed on the computer and signed electronically. Generally the applicant does not need to fill out a new application but will meet in person with the HRA employee and complete the re-certifcaition. Each of the recertificaiton’s will be entered into evidence in the criminal trial. If a target letter was initially sent to the applicant, then they will introduce the actual target letter.