New York City has contracts with several insurance carriers to provide free or low cost health insurance to New York City residents who financially qualify. The City, through the Human Resources Administration (HRA) pays monthly premiums to the carriers on behalf of eligible Medicaid recipients.
To qualify, the applicant must reside in New York City, have sufficiently low income, and have resources within the allowable limits. Resources include most real properties, money, stock, and valuables. All income and resources must be disclosed during the application and re-certification process and updated regularly as needed.
Most recipient Medicaid fraud cases in New York City involve clients lying on their Medicaid applications, whether failing to disclose their incomes, including rental incomes, or properties. That constitutes fraud. The HRA Bureau of Fraud Investigations is charged with investigating cases of Medicaid Fraud in New York City. If caught, the consequences may range from simply repaying the City for the services received to civil actions to criminal prosecutions. More cases are prosecuted this year than in previous years.
Criminal charges for Medicaid fraud in New York City may include Grand Larceny, Welfare Fraud, and offering a False Instrument for Filing. All charges are usually felonies in various degrees depending on the amount of money paid by the City. Because many recipients conceal their incomes on their tax returns and then unwisely produce the returns to the BFI investigators, cases may be referred to the IRS or NYS Department of Taxation for further tax evasion investigation resulting in additional tax fraud charges.
If you are investigated for Medicaid Fraud in New York City, call us at 212-577-6677 before talking to investigators.
