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Medicaid Fraud Investigation Representation

Medicaid is a federal and state government-sponsored health coverage insurance program. It is managed by States and is offered free of charge to the individuals and families that meet certain maximum income and, in certain situations, also maximum resources (savings, fair market value of assets, etc.) requirements. Thus, Medicaid is a means-based program. In order for someone to receive Medicaid, they must be a U.S. citizen, or a legal permanent resident, and this includes disabled persons, low-income adults and their children. Today, Medicaid is the largest source of medical funding in the United States for people living on a limited income.

There are numerous situations in which individuals who are or have been receiving Medicaid coverage were or are in fact not eligible to receive such benefits. This could be due to a number of reasons, such as, but not limited to, individuals and /or families providing inaccurate financial, household, or personal information to the government when applying for Medicaid coverage and/or not notifying the government once the individual's or family's financial or personal information has changed. Personal financial information can change for a number of reasons, such as one of the members of the household getting a job or making more money, receiving gifts, inheritance, personal injury settlement or other inflow of income and/or assets. One must be very mindful of the fact that even if the resources/assets/savings test does not apply in certain Medicaid programs, the inflow of resources/assets/savings is generally considered to be income in the month received and consequently renders individuals ineligible for Medicaid due to the violation of the income test.

The office of Human Resources Administration or other similar governmental institutions that administer and enforce Medicaid laws routinely conduct independent research to ensure that only those who are truly eligible for Medicaid coverage are in fact receiving most valuable Medicaid benefits. The government receives data feeds from many different governmental as well as private institutions, including banks. Once the government becomes aware that at any point in time the individual was over the required maximum allowed resources and/or income level, this generally triggers a Recipient Medicaid Fraud Investigation by the administrative agency. These Medicaid Fraud Investigations are in a rise, due to the government being aware of the significant Medicaid Fraud perpetrating my many individuals and families, the fact that the government needs money, as well as the fact that the government has invested significant resources into various research databases to identify and prosecute those who commit Medicaid Fraud. The government can and does prosecute individuals civilly and also criminally.

Medicaid Fraud Representation Attorneys

Need an attorney for a Medicaid fraud case in New York? Melnik Law Group, PLLC, Inc is a national professional organization that specializes in representing individuals and their families who received Medicaid Fraud, Family Health Plus Fraud, or other Medicaid-related Fraud Investigation Letters or other forms of contact in front of the office of Medicaid. If you are the subject of an investigation or believe that you are not eligible to receive for Medicaid coverage you are currently receiving, it's absolutely critical that you speak with an Melnik Law Group, PLLC' experienced attorney before you speak with any Medicaid investigators and hopefully before you even receive a letter from Medicaid Fraud Investigation Division. Due to the high incidence of Medicaid fraud, more and more people have been investigated recently and whether or not you are guilty, it's important that you be represented by an attorney who specializes in Medicaid Fraud Defense.

For many years the attorneys and professionals of Melnik Law Group, PLLC have successfully been assisting their clients who were faced with Medicaid Fraud Investigations. We are proud to report that not a single client represented by our professionals has ever been prosecuted criminally. Our professionals have always found a way to settle with the office of Medicaid and most of the time individuals were able to already legally continue to receive Medicaid benefits.

Medicaid Fraud Investigation Interview

Please keep in mind that if you receive a letter in the mail from an investigative agency asking you to appear in person for an "interview," and to provide them with certain documentation, then we strongly advise that you contact Melnik Law Group, PLLC attorney at your earliest convenience. We would stand between you and the government and do everything possible to prevent any criminal investigation, settle government's claim and ensure that there is no interruption of Medicaid coverage – all results of course will be based on individual facts and circumstances.

Additionally, if you voluntarily appear at the interview and provide the requested documentation, you could be inadvertently implicating yourself or confessing to a crime unknowingly, or a crime you did not really commit. Your goal should be to do everything possible to prevent the Medicaid Fraud Investigation Division from referring your case to the local District Attorney's Office for criminal prosecution, or to the litigation department. When this happens, anything you say, and any information you provide to the investigators can and will be used against you in a court of law.

Criminal Prosecutions for Medicaid Fraud

When Medicaid recipients are under close scrutiny for "questionable" behavior, their information is reviewed by the Health Department's Office of Medicaid Management. This is the department that investigates potentially fraudulent behavior and in certain circumstances some cases are referred to the appropriate government authority for criminal prosecution such as Criminal Court.

Often times people aren't aware that they are under investigation for Medicaid Fraud until after they receive a letter from the Human Resources Administration or other government entity. If you realize that you have committed fraud unknowingly or accidentally, or may not be now or may not have been in the past eligible to receive Medicaid benefits, then you should be proactive and discuss your situation with our professionals before the government contacts you. The government can go back years when investigating people who stopped receiving Medicaid coverage years ago, so not only current recipients are at risk of Medicaid Fraud Investigation and Prosecution.

You can be subject to a Medicaid Fraud Investigation if:

  • You are intentionally lying/concealing or inadvertently omitting (even if by mistake) information about your, your spouse's or another member of our household's income or assets on the Medicaid application.
  • You failed to report income, money or other resources received by you, your spouse or other member of your household (Including foreign income and assets)
  • Failure to report any changes to you, your spouse's or another member of your household's living situation, income or assets while receiving Medicaid coverage.
  • Illegally selling your prescription medications that were obtained through Medicaid
  • Allowing someone else to use your Medicaid card or obtain services in your name
  • Obtaining and using multiple Medicaid cards
  • Receiving services that you are not eligible for through intentional misrepresentation on your part
  • Failure to report receipt of foreign pensions or other income
  • Committing prescription fraud (altering or forging prescriptions)
  • Other situations as outlined within applicable rules and regulations

In recent years, there has been a significant increase in the number of civil and criminal prosecutions of individuals who commit Medicaid fraud. When people are found obtaining government health care services illegally, they potentially face criminal prosecution by the District Attorney's Office, loss of rights to future government benefits and sometimes prison terms. This means that the Medicaid recipient could be indicted on multiple felony charges including Medicaid fraud and grand larceny, money laundering – all of which can result in years behind bars in prison. Sadly, a number of Medicaid recipients have no idea that they are under investigation until after they receive a letter or a phone call from the District Attorney's Office, telling them to surrender to the DA in order to face felony charges.

Melnik Law Group, PLLC Can Help!

As an organization that specializes in Medicaid Fraud representations, professionals who are members of the Melnik Law Group, PLLC team have helped countless individuals and families who were being investigated for Medicaid Fraud. In each and every case, our professionals were successful at preventing criminal charges from being filed in the first place and whenever possible protecting our client's rights to future benefits! If you or someone you know has been contacted by investigators in regards to an ongoing or past Medicaid fraud investigation, or even if you haven't been contacted yet, don't be part of the statistics – call us today for a free case evaluation.

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The information on this website is for general information purposes only. Nothing on this site should be taken as legal advice for any individual case or situation. This information is not intended to create, and receipt or viewing does not constitute, an attorney-client relationship.