Written by attorney Todd Andrew Spodek

A Guide to HRA Fraud Investigations by the Bureau of Fraud Investigation for Medicaid Fraud

In this video, NY Medicaid Fraud Lawyer Todd Spodek discuses the Human Resources Administration investigaiton process. Let's start in the beginning, you received a target or call letter requesting that you come down for an initial interview at one of the HRA offices. The letter was likely hand delivered to you or mailed to you. This letter is going to tell you a few important things about the details of your particular investigation.

  1. That you are being investigated for possible medicaid fraud.
  2. That an interview has been set up with you at one of the HRA offices.
  3. It is going to ask that you come bring various documents with you regarding your income, your assets, your residence and your family size.

Now there are three HRA offices in NYC in which the HRA investigators are based out of. One is located at 250 Church Street, down the block from our office. One is located at 151 West Broadway which is around the corner from our office and there is 320 Schermerhorn in Brooklyn where the food stamp fraud investigators are.

Initialy, we are going to look through your income to determine whether you are eligible for medicaid benefits. We want to know your eligibility for each year, and even portions of the year. This is important because this can reduce the overall claim against you. Now if you received benefits not only for you, but your children spouse as well - we will want to see the income and resources of everyone in your family.

Our initial goal is to reduce the claim period. The smaller the claim period, the smaller the potential restitution.

After we look at your income, we want to see the initial applicationthat you filled out. Who did you say you live with? How much did you say you make? Not only do we want to see the initial application but we want to see each and every recertification. This way we can get a thorough understanding of whether you are eligible or not. Now, in that application you are swearing that everything is true and that everything you are providing is true and accurate at that time.

There are two issues with the medicaid applications:

  1. Intentionally providing false information - You say you live by yourself, but you actually live with your husband, boyfriend, your cousin.
  2. Omitting material information - You say you work one job, but you actually work two jobs.

After we analyze your income and applications now we want to know your current financial situation. Do you own or have an interest in a business? What is your current income? What are you current assets? All of these details will affect the type of resolution.

In certain situations, we might have your fill out a financial maintenance form to show the hardship you are currently going through.

Now some of our clients have substantial assets, resources - this type of situation we would never recommend you filling out a financial maintenance form. You can be worsening the situation and putting yourself in harms way.

Now at this point we will go down and meet with the investigator. No point do we recommend you going there because you can't necessary help us at this juncture.

We will go down there and handle this. We have the information, we have the documents and we know how to navigate HRA professionally and efficiently. So we go there on your behalf and we talk to the investigators about why we think you were eligible at certain times.

Now a lot of clients don't understand is that medicaid is like car insurance. The premium is paid every month or whether you go to the Dr or not. It only goes up with use.

We often hear from clients that they should not be liable because they had private insurance at the time and the never used medicaid. There is a misconception as to how medicaid works. Medicaid is taking taxpayer money and paying the premiums for you and your family. Now those premiums vary and can be easily $400 every month. Now imagine the cost with surgery, pregnancy - the amount gets high. Imagine the total cost over 2-3 years.

Feel free to contact me directly with any questions. Thank you.

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