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Medicaid Fraud Settlement Agreement

In 2013, the Human Resources Administration made drastic changes to the way they settle cases. With the assistance of the New York Law Department they drafted a Settlement Agreement that now encompasses a release.

Previous Version of the HRA’s Medicaid Fraud Settlement Agreement

The Settlement Agreement will be issued from the NYC Human Resources Administration Department of Social Services however it will be usually now come from the Investigation, Revenue and Enforcement Administration Bureau of Fraud Investigation. Their office is located at 250 Church Street, 3rd Floor New York, NY 100013. The settlement agreement will have two options both with their own advantages and disadvantages. Once is payment in full of a negotiated claim. This is a lump sum payment. The second option is installments with no initial payments made.

The terms and conditions of the Human Resources Administration settlement agreement are as follows:

The benefits recipient acknowledges and admits his or her indebtedness to the Department of Social Social of the City of New York

The benefits recipient agrees to pay registration for Medical Assistance/Family Health Plus (MA/FHP) incorrectly received during the claim period

The settlement amount will be paid in full satisfaction of the claim

The benefit recipient agreement to make restitution is not to be construed as an admission of wrongdoing on behalf of the medicaid recipient

The settlement only pertains to the MA/FHP benefits received and has no bearing on any other type of assistance in which the medicaid recipient was receiving at any point. This would include food stamps, SNAP, cash assistance, etc.

The settlement agreement does not cover the other the other benefits

HRA retains it’s full right of recovery on claims related to non MA/FHP benefits

HRA will certify the amount paid to date, and the balance amount to be paid

HRA will certify the monthly installment note and that it will be in equal amount except the final installment payment which might be a lesser amount

The form of the monthly payments to HRA shall be certified check, bank check, cashier’s check or money order

The restitution payments to HRA shall be made to:

New York City Department of Social Services
Division of Accounts Receivable and Billing
180 Water Street, 9th Floor New York, NY 10038

If the medicaid recipient is paying by installments then the Division of Accounts Receivable and Billing (DARB) will send a monthly billing invoice to the address you choose.  This invoice should be included with your payment to confirm that you receive credit.

DARB can be reached at (929) 221-6054 or (929) 221-6060

The most important part of the settlements agreement with the New York City Human Resources Administration (HRA) will be the provision regarding the recipient’s release of liability. This is the provision that should be focused on the most as this will prohibit HRA from referring this particular claim for civil or criminal prosecution.

The release provision will state that HRA agrees not to take further action as long as the undersigned makes timely payments. In the event any default or failure to pay any installment payment when due then DARB will send written notice by ordinary mail at the address the recipient provided at settlement. There is a 15 day grace period to cure the breach and avoid default. It is important to note that the HRA settlement agreement includes an acceleration clause which means that upon default without cure, the full amount becomes payable. HRA can then sue on the note and potentially collect on the full amount. HRA can also avoid taking any action for default and allow you to remain in default and still exercise this right to sue for the full amount.

HRA will also require the medicaid recipient acknowledge that he or she fully understands the terms and conditions of the settlement agreement and is executing this agreement freely and voluntarily.

The settlement agreement with HRA will state that the agreement may not be changed, altered, amended or modified except in writing and signed by the department.

The settlement agreed should always be signed by a senior medicaid fraud investigator or assistant directory. They sign as an authorized representative of HRA.

If you have any questions regarding a medicaid or food stamp fraud investigation call us 24/7 at (212) 300-5196.

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