A lot of NYC residents receive health care through the Medicaid program. By its nature, it is a complex mechanism that is hard to ensure and track compliance with, which results in billions of dollars wasted. To minimize this sum and recover at least some of it into the local and federal treasuries, the government sends its investigators to look into alleged Medicaid fraud. In this article, our lawyers explain how such investigations are carried out and what are their consequences.
Medicaid fraud investigations in New York City have been on the rise for several years. Most of them usually resulted in non-criminal dispositions. However, the certain categories of Medicaid beneficiaries have been hit more often then others and some of them have been consistently prosecuted in criminal courts at much higher rates compared to the other groups. With the recent Human Resources Administration management shuffle, which occurred since Mayor DeBlasio took office, there has been a spike of criminal prosecutions for Medicaid fraud in NYC. Some of the most consistently targeted groups are the spouses of MTA (Metropolitan Transit Authority) employees. This article explains why MTA employees’ families are targeted by fraud investigators, what raises red flags before the investigation begins, what the consequences of such fraud are, and how to protect against them.
Anatomy of a Medicaid fraud case
In very basic terms, Medicaid fraud occurs when the benefits recipient makes a false statement about their household income to the government agency responsible for administering the program. In NYC such agency is the Human Resources Administration. In order to qualify for any of the public benefits programs, the recipient household income must not exceed a certain level. The reality is that the edibility levels are pretty low, making it very difficult for most families to qualify for Medicaid.
The main issue arises when it comes to determining the household income. Married couples are considered one household in most cases, even if they don’t live together on a full time basis. This includes the families where spouses simply don’t get along together and may choose to live separately for some time. These “on and off” relationships are very common. The same rules apply to couples that have children together but are not formally married.
In such cases, not disclosing the fact that the couple is married, may be considered fraudulent.
Furthermore, the applicant must disclose all types of income, including earned and unearned income, and all types of contributions and financial support from anyone else.
Making a false statement on an application for any public benefits is a crime and can give raise to criminal investigation , arrest, and prosecution.
Why MTA employees’ families are targeted
As stated above, MTA employees’ families are specifically targeted by NYC fraud investigators. Traditionally, City and other public sector employees have been the subject of increased scrutiny when it comes to public benefits fraud such as Medicaid, Section 8, and food stamps. Each year our office represents a number of spouses of MTA workers who were receiving some of these benefits. There are several reasons this group is singled out. First, it is easy for the city agency such as the HRA to access employment databases of other government agencies such as the MTA. In fact, the HRA maintains some of the most sophisticated computer records matching databases in the country, making employment and wages searches quick and efficient. Second, most MTA employees’ wages are high enough to disqualify their households from all public benefits programs. Third, all MTA employees have health insurance, which automatically disqualifies their families from Medicaid. These three facts combined make almost a guarantee that when the HRA database match comes up with a name of a recipient who is married to or has children with a MTA worker, further inquiry will prove that fraud took place.
So, in short, MTA spouses make an easy and soft target, which is why they are targeted at a higher rate than other recipients. The same applies not only to MTA but also to other government or government-related agencies such as ConEd, FDNY, and even the Department of Corrections.
What Raises Red Flags
As stated above, the HRA uses very sophisticated databases to access all sorts of information. The goal is to come up with evidence that (1) the family lives together, as one household, and (2) that has not been disclosed, and (3) the household income (combined) exceeds the allowed limit, making the recipient ineligible. Therefore, the following factors generally raise red flags, triggering a fraud investigation:
- Birth Certificate information showing the MTA worker as the father of the children who receive the benefits
- MTA employment records showing the father’s address as that of the recipient family
- DMV records (including the driver’s license) that have the same address
- Joint bank accounts
- MTA spouse receiving mail at the address where the family lives
- Auto insurance records showing both spouses on the same policy
- Jointly filed tax returns
- Both spouses’ names appearing on property deeds
HRA fraud investigators have access to numerous databases that can reveal these facts. Once there is a match, they will automatically start to look into the case, conducting additional investigation. They may and often do visit the recipient family’s home and check who lives there. They may speak to neighbors and building supers to see if the husband actually lives at the address.
Consequences of Medicaid Fraud
Once the investigation is completed, the recipient spouse will often receive the interview letter requesting her to come in for the “interview”. In reality, this is often no more than a pretext to get her to come in so that she could make incriminating statements. The investigator already has most of the documents, even though the interview letters lists many documents the recipient is to bring with her. So, the best advice we give our client is to call an experienced Medicaid fraud attorney before speaking with the investigator. The worst-case scenario in cases involving spouses of MTA employees on public benefits is criminal prosecution. If the agency determines to press criminal charges, it will refer the case to the District Attorney’s Office and eventually the target spouse will be contacted by a detective with the DA Detective Squad. That process takes approximately 8-12 months. Because the Medicaid program paid for the recipient’s medical coverage, the City wants to recoup the money and the fraud itself is a financial crime. The spouse will then be arrested and charged with several felony counts, which include Welfare Fraud and Grand Larceny.
Consequences of this may include having a permanent criminal record, immigration issues for non-citizens, loss of employment, and professional discipline for those holding professional licenses.
How to protect yourself
There are many ways to avoid legal trouble when applying for Medicaid and other public benefits. The best and most effective way to stay safe is not to commit fraud. Unfortunately, many cases involve situations where the applicant really is unaware that her actions could be fraudulent. For example, in “on and off” sort of family relationship, many women leave out the information about the husband or partner because in their mind they don’t live together.
If you received an interview letter from the HRA, speak to our experienced NYC Medicaid fraud lawyers. We have handled hundreds and hundreds of Medicaid fraud cases in New York, including scores of cases involving MTA employees. Call us today at (212) 577 6677 before speaking with the investigators.
Can I Be Deported For Medicaid Fraud Or Welfare Fraud In New York City?
At Joseph Potashnik and Associates PC we deal with criminal Medicaid fraud cases on a daily basis. In our practice we see a number of non-US citizen clients accused of Medicaid fraud or Welfare fraud. One of the main problems faced by non-citizens accused of criminal acts is immigration consequences of a criminal conviction. The issue of being charged with a crime when you are not a citizen is crucial and I’ll analyze its main points in this post.
First, committing a crime is not in itself grounds for deportation. However, being convicted of a crime may be. There are two basic types of crimes that could result in deportation. One is a crime of moral turpitude, and the other is something the federal law considers an aggravated felony.
What is and is not a crime of moral turpitude is a matter of a separate discussion, but for our purposes, most theft related crimes are considered a crime involving mortal turpitude, meaning that the person who has been convicted of this crime (or pled guilty to it) is not fit to be a US citizen and may be subject to deportation. An aggravated felony, on the other hand, is something else, but as applied to theft crimes, it the theft involved more than $10,000 and/or if the sentence for the crime was one year in jail or more, the crime is an aggravated felony for immigration purposes. This means that the alien convicted of it is subject to deportation.
Medicaid fraud or welfare fraud are just special names for an old fashion fraud, or theft. Defendants accused of lying on their public benefits applications in order to get benefits for which they are ineligible commit larceny, which is charged not only as larceny (theft) but also as welfare fraud and filing of a false business instrument.
If the case is still in its early investigative stage, it is always better to prevent criminal charges from being filed in the first place. This solves all the problems at once. Unfortunately, it is not always the case and many individuals in New York City are criminally charged for public benefits fraud (including Medicaid, food stamps, welfare, and Section 8) in New York City every year. They are all charged with grand larceny if the amount of benefits received exceeds $1,000.
For those defendants who have not became US citizens, this means that if the case results in a criminal conviction, the prospect of deportation is close and very real. It doesn’t matter that you’ve live in this country for many years, that you have family and business, and paid your taxes. If you are not a citizen, a criminal conviction for fraud will become a problem for you.
There are some ways a good criminal lawyer can minimize the possibility of deportation, or at least make your immigration case easier to defend. Of course, if there is a valid legal defense to welfare fraud charges, they must be fully exploited. But even if the case is indefensible, not all is lost. For example, we can negotiate with the prosecutor a deal that allows the defendant to plead guilty to a charge that doesn’t make the defendant automatically deportable.
This is one of very few (but very effective) techniques that experienced defense lawyer can use. In some cases, we can reach a deal under which the defendant is allowed to pay restitution administratively, before the charges are filed, so that the outstanding balance is under $10,000 and the defendant will be charged with stealing under $10,000, which may resolve the issue of aggravated felony.
If you are a target of a fraud investigation or have been charged with Medicaid or Welfare fraud in New York City, our experienced NYC criminal lawyers are here to help you.
Call us today at (212) 577-6677 to set up an immediate consultation.