John Howley's Medicaid Fraud Blog

Responding to Medicaid Fraud Investigation Letters

12/1/2015

Every year, thousands of people receive Medicaid fraud investigation letters from the NYC Human Resources Administration (HRA). The letters ask you to bring tax returns and other financial documents to an “interview” with an HRA fraud investigator.

The “interview” is actually an interrogation. You will be placed in a small, windowless conference room with two investigators. The investigators will make copies of any documents you bring. Then one of the investigators will question you, while the other one takes notes.

By the time you receive the letter, the HRA fraud investigators have already completed most of their investigation. They know where you live, who lives with you, and whether you own or rent your home. They know where you work, how much you earn, and how much money you have in the bank. They know whether you own a car and, if so, how much you pay for it. They may even have photographs of you, your home, your family, and anyone else who lives with you.

If you agree to be “interviewed,” the HRA fraud investigators will use anything you say to build a case against you.

You must respond to the letter, but you do not have to face the HRA fraud investigators alone. In fact, you may not have to meet with them at all.

An experienced Medicaid lawyer can contact the investigators for you. Your lawyer can find out why you are the target of a Medicaid fraud investigation before you provide any information or documents. Once your lawyer understands what the issues are, he can work with you to build your defense.

In many cases, an experienced Medicaid lawyer can resolve the investigation without any criminal charges or civil lawsuits.

Your chances of a favorable outcome increase dramatically if you get the Medicaid lawyer involved early in the process, before you meet with the HRA fraud investigators or turn over any documents.

To schedule a free and confidential consultation with an experienced Medicaid lawyer, call John Howley, Esq. at (212) 601-2728.

When Healthcare Fraud Becomes a Criminal Offense

8/13/2015

Exploring the Factors that Turn an Overbilling Dispute into a Lengthy Prison Sentence

Every day I read the press releases from healthcare fraud prosecutors around the country describing how some cases settle for millions of dollars with no criminal charges, while other cases result in lengthy prison sentences even though much less money was involved. Two cases that came to my attention today illustrate when and how a healthcare fraud dispute becomes a criminal offense.

The first case involves a former chiropractor who was accused of submitting a little more than $180,000 in false claims. He was sentenced to 44 months in prison and an additional three years of supervised release after pleading guilty to health care fraud. He was also ordered to pay $183,674.14 in restitution.

As far as health care frauds go, this one did not involve a tremendous amount of money. There were several factors, however, that made this a criminal case.

First, the former chiropractor was already serving 60 months in prison on charges of domestic abuse and battery involving strangulation.

Second, the former chiropractor was accused of billing for chiropractic services, back braces, and X-rays that he did not actually provide to patients.

Third, the former chiropractor was accused of inducing patients to agree to an expensive test that they did not want or need by agreeing to reduce or eliminate their co-payment if they agreed to let him perform the test.

Fourth, the former chiropractor was accused of fraudulently billing for services using physician provider numbers without authorization, or on days when the physicians were not working in his clinic.

In contrast, a second case that came to my attention involved an $8 million settlement of false claims that will result in no criminal prosecution at all if the defendant complies with the terms of a deferred prosecution agreement.

An OB/GYN in New York was accused of submitting more than $8 million in false claims to Medicare by billing for services provided by unlicensed and unsupervised staff. Instead of going to prison, however, this physician was able to negotiate a deferred prosecution agreement.

Under the agreement, the physician will pay back the disputed amount and will retain an independent billing monitor to oversee the billing in his practice. If he complies with the terms of the deferred prosecution agreement for a period of two years, the prosecutors agree to drop the criminal charge against him.

Unlike the chiropractor in the first case, the OB/GYN did not have any other criminal problems and was not billing for services that were not provided or that were not medically necessary. By retaining an experienced Medicare fraud criminal defense attorney early in the process, he was able to highlight these facts and others to prosecutors, with a very favorable result.

John Howley, Esq.
(212) 601-2728

OB/GYN Avoids Criminal Prosecution for Medicare and Medicaid Fraud

8/11/2015

Doctor Will Pay More Than $8 Million and Install Billing Monitor to Settle Civil Fraud Investigation

A Board Certified Obstetrician and Gynecologist (OB/GYN) has entered into a civil settlement agreement with the United States and New York State that will defer and possibly avoid any prosecution under criminal statutes.

Haroutyoun Margossian, the OB/GYN, signed the agreement on behalf of himself and his practice, NY Urogynecology & Reconstructive Pelvic Surgery, P.C. The agreement resolves an investigation under the federal and state False Claims Acts involving allegations that, in contravention of Medicare and Medicaid regulations, the OB/GYN employed an unlicensed and often unsupervised staff to treat women suffering from urinary incontinence.

The OB/GYN will pay a total of $8,047,291.06. He will also be charged criminally with making false statements to Medicare, but the government will defer prosecution of the criminal charge.

The deferred prosecution agreement requires the OB/GYN to install an independent billing monitor for his practice and to pay the $8 million civil settlement amount. If the OB/GYN complies with all the terms of the deferred prosecution agreement for two years, the government will seek dismissal of the criminal charge.

This case highlights the importance of retaining an experienced Medicare and Medicaid fraud defense attorney early in an investigation. By engaging with government investigators and prosecutors before any charges are filed, an experienced defense attorney can often avoid criminal charges or minimize their severity.

John Howley, Esq.
(212) 601-2728

What Is Medicaid Recipient Fraud?

5/20/2014

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Medicaid Recipient Fraud Investigations Can Lead to Civil Lawsuits or Criminal Charges

Every year the New York City Bureau of Fraud Investigation opens more than 5,000 investigations into individuals and families who receive Medicaid, Family Health Plus, and Child Health Plus benefits. All three of these programs are funded, at least in part, by Medicaid.

The investigations are designed to find out whether the people who are using these benefits are actually eligible to receive them.

The investigators are also trying to determine whether the individual or family committed fraud by providing false or misleading information on their applications and re-certifications.

The most common types of Medicaid recipient fraud are:

Underreporting your income
Failing to report all of your income, such as rent from tenants
Failing to report a spouse’s income
Not accurately disclosing your expenses
Misrepresenting that you live in NYC when you actually live somewhere else

If the investigators determine that you have committed Medicaid fraud, then they have several options. First, they can ask you to pay back any benefits you received when you were not eligible. Second, they can refer your case for civil litigation. Third, they can refer your case for criminal prosecution.

What happens in your case depends on how you respond to the investigation.

If you have received a letter from an investigator with the Bureau of Fraud Investigation, then you should consult with an experienced Medicaid fraud lawyer immediately to protect yourself.

To arrange a free and confidential consultation with an experienced Medicaid fraud lawyer, call John Howley, Esq. at (212) 601-2728.

John Howley, Esq.
350 Fifth Avenue, 59th Floor
New York, New York 10118
(212) 601-2728

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Never Talk to a Medicaid Fraud Investigator Without First Consulting an Experienced Medicaid Fraud Lawyer

4/18/2014

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Anything You Say Can and Will Be Used Against You

Every week, I receive at least 5 calls from clients who made the same stupid mistake. They spoke to a Medicaid investigator from the Bureau of Fraud Investigation before they consulted with a lawyer.

It usually begins innocently. An investigator sends the client a letter asking for information. The client calls the investigator, who starts asking questions about where they live, where they work, where their bank accounts are, and how much they earn.

By the time the phone call ends, the client is in big trouble.

Take the client who called today. He received a letter stating that he owed $15,800 for Medicaid benefits during a period when he was not eligible. He called the Medicaid fraud investigator to find out how this happened. The investigator started asking questions about his employment, family, and income. Wanting to appear cooperative, the client answered all of the Medicaid investigator's questions.

At the end of the phone call, the investigator was very polite. She said "thank you" and promised to send the client a new letter with a different amount.

The new letter demanded that the client pay $48,300, or more than three times the original amount.

Do not make the same mistake. An experienced Medicaid fraud lawyer can speak to the investigator for you, find out what the problems are, and help resolve the problems without making them worse.

Here is what you need to now if you receive a letter from the Bureau of Fraud Investigation:

You have the right to remain silent and to consult with a lawyer. Over the past 250 years, tens of thousands of Americans have died in wars to protect those rights. Say nothing. Call a lawyer. It is the least you can do to honor the bravery of those who ensured you have those rights.
Initial consultations are free and confidential. An experienced Medicaid fraud lawyer will review your tax returns, bank statements, and other documents to determine whether you have a problem. If you have a problem, the lawyer will tell you how to handle it.
If you need help from a lawyer, the fees are reasonable. Sometimes you can resolve an investigation on your own, without a lawyer. Other times, you may face civil litigation or even criminal prosecution that can send you to prison. Each case is different. Only an experienced Medicaid fraud lawyer can advise you after reviewing your documents.

To arrange a free and confidential consultation with an experienced Medicaid fraud lawyer, call John Howley, Esq. at (212) 601-2728.

John Howley, Esq.
350 Fifth Avenue, 59th Floor
New York, New York 10118
(212) 601-2728

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Why Did I Get a Letter from the Bureau of Fraud Investigation?

3/14/2014

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You Are Under Investigation for Medicaid Fraud

If you received a letter from the Bureau of Fraud Investigation, then you are currently under investigation for Medicaid fraud.

Most people who receive these letters are shocked. Maybe they provided inaccurate or incomplete information on their application. But they never intended to commit fraud.

Here’s the problem. When you sign an application for Medicaid or Family Health Plus benefits, you certify under penalty of perjury that you are providing true, accurate, and complete information. If your application contains inaccurate or incomplete information, then you may be prosecuted for a crime.

Most of the cases investigated by the Bureau of Fraud Investigation involve one or more of the following situations:

failing to disclose changes in your employment or income
providing a false address or failing to disclose a second home
failing to disclose everyone who lives with you
falsely claiming that you were separated from your spouse
failing to disclose rental income or income from a business
failing to disclose bonuses or other income not on your pay stubs
failing to disclose financial support from family members

If the investigator determines that you intentionally provided false, misleading, or incomplete information on your application or recertification, they may refer your case to the District Attorney for criminal prosecution. And if you are convicted, you could be sentenced to up to seven years in prison.

Or the investigator could decide to let you settle the case by paying back the benefits that you received when you were not eligible. In that event, there will be no criminal charges, no prison sentences, no impact on your credit report, and no adverse immigration consequences.

How do you settle an investigation and avoid criminal charges? That all depends on your specific facts and circumstances – and on how you handle the investigation.

If you receive a letter from the Bureau of Fraud Investigation, then you should consult with an experienced Medicaid fraud attorney immediately to protect your rights. Your attorney will review your financial documents, explain whether you have a problem, and help you develop a strategy designed to avoid potentially devastating consequences.

To arrange a free and confidential consultation with an experienced Medicaid fraud attorney, call John Howley, Esq. at (212) 601-2728.

John Howley, Esq.

The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for advice regarding your individual situation. I invite you to contact our law offices and welcome your calls, letters and electronic mail. Contacting us does not create an attorney-client relationship. Please do not send any confidential information to us until such time as an attorney-client relationship has been established. I practice law and offer legal services only in jurisdictions where I am properly authorized to do so. I do not seek to represent anyone in any jurisdiction where this web site does not comply with applicable laws and bar rules.

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Felony Charges for Personal Care Attendant Medicaid Fraud

12/25/2013

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A personal-care attendant was arrested and charged with felonies after an investigation by the Attorney General’s Medicaid Fraud Control Unit for submitting false claims to Medicaid for services that were never provided.

The woman had worked as a personal-care attendant for a Medicaid beneficiary. She was caught when the patient’s spouse told investigators that the woman had stopped assisting the beneficiary and no longer lived in the area.

A felony is a very serious crime that carries a penalty of one year or more in prison. Conviction of a felony charge also results in immediate exclusion from Medicaid, Medicare and other government healthcare programs. You almost always lose your professional license as well.

In this case, the personal-care attendant was able to avoid prison by entering into a plea agreement. After pleading guilty to one count of Medicaid Fraud, she was sentenced to five years of probation, fined almost $30,000, and ordered to pay restitution of $9,468.48 to the Medicaid program.

If you are under investigation for Medicaid fraud, or if you have been charged with a crime, then you need to consult with an experienced Medicaid fraud defense attorney immediately to protect your rights. For a free initial consultation, call John Howley, Esq. at (212) 601-2728.

John Howley, Esq.

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Medicare Fraud Strike Force Goes After Home Healthcare Fraud

8/26/2013

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A patient recruiter and the owner of a home healthcare staffing company face up to 10 years in prison after pleading guilty to a conspiracy to commit health care fraud.

The guilty pleas were the result of an investigation by the federal Medicare Fraud Strike Force. The Strike Force is an inter-agency effort to investigate and prosecute Medicare fraud across the country.

In this case, the investigation was conducted jointly by the Federal Bureau of Investigation (FBI) and the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG).

The patient recruiter pleaded guilty to supplying Medicare patients to a now defunct home healthcare agency that billed Medicare for expensive physical therapy and home health care services that were not medically necessary and/or were not provided.

As part of the scheme, the patient recruiter paid kickbacks and bribes to co-conspirators in doctors’ offices and clinics in exchange for prescriptions, medical certifications, and other documentation. The patient recruiter used the false medical records to bill Medicare for home health care services and physical therapy that had not been provided and/or were not medically necessary.

The government alleges that Medicare paid approximately $7 million based on fraudulent claims for home health care services that were not medically necessary and/or not provided.

When the government investigates and prosecutes Medicare fraud, it has tremendous resources at its disposal.

If you are under investigation or have been charged with a crime, then you should consult with an experienced Medicare and Medicaid fraud defense attorney immediately to protect your rights, your livelihood, and your freedom.

Call John Howley, Esq. at (212) 601-2728 to arrange a free and confidential consultation.

John Howley, Esq.

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Change of Residence Results in Medicaid Fraud Charges

7/12/2013

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A woman from Lake George, New York, has been charged with Medicaid fraud because she allegedly continued to receive Medicaid benefits from New York State after moving to Massachusetts.

The woman was arrested and charged with fourth-degree grand larceny, a felony that carries a possible prison sentence of more than one year, and fifth-degree health care fraud, a misdemeanor.

A government press release said the woman was arrested after she moved back to New York State recently. She is accused of receiving Medicaid benefits from New York State for three months when she lived in Massachusetts.

This case should be watched carefully because of the relatively short time she spent outside New York State. New York courts have held that individuals and their families do not automatically lose their New York residence status for Medicaid eligibility purposes merely by leaving the state, even if they remain outside the state for a substantial period of time.

If you are under investigation for Medicaid fraud or have been charged with a crime, then you should consult with an experienced Medicaid fraud attorney immediately to protect yourself.

To arrange a free and confidential consultation, call John Howley, Esq. at (212) 601-2728.

John Howley, Esq.

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What is Medicaid Eligibility Fraud?

7/11/2013

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Every year, the Bureau of Fraud Investigation conducts investigations and interviews of more than 5,000 New York City residents about their eligibility for Medicaid.

Your first notice of the investigation is usually a letter from the NYC Human Resources Administration asking you to bring your tax returns and other documents to an “interview” at 151 West Broadway in lower Manhattan.

By the time you receive this letter, the Medicaid fraud investigator has already conducted an investigation. They know where you live, who you live with, where you work, and whether you own a home or a car.

They also have all your applications and re-certifications for Medicaid. If the information they have gathered in their investigation is different than what you put on your application and re-certification forms, then you could have a very serious problem.

You should get advice from an experienced Medicaid fraud attorney. Your lawyer can help you present your case and negotiate a resolution in an effort to avoid criminal charges.

The most common types of Medicaid eligibility fraud include:

Your Income: Your eligibility for Medicaid, Family Health Plus, and Child Health Plus is based on your monthly income. If your income exceeds the eligibility levels for these programs, then you are not eligible to receive benefits.

Understating your income, or failing to disclose income from a spouse or rental property, is a type of Medicaid fraud. It can result in a lawsuit against you for restitution – that is, the City can sue you to pay back all the benefits you received. Misrepresenting your income can also result in criminal charges being filed against you.

The Bureau of Fraud Investigation has a number of ways they can discover what your actual income is. Sometimes they ask your employer for payroll records without telling you. other times they infer what your income must be based on your expenses. For example, if you wrote that your income was only $1,000 per month, but public records show that you are paying a $2,500 per month mortgage, then they will infer that your income must be more than what you said it was.

Your Residence: Eligibility for Medicaid and Family Health Plus is based on where you live. If you are receiving these benefits through the New York City Human Resources Administration, then you must be a New York City resident.

People sometimes move out of New York City and fail to change their address for their Medicaid and Family Health Plus benefits. This creates a problem.

Even if your income is still below the eligibility levels for Medicaid where you live, you do not qualify for benefits from New York City. You may be asked to pay back thousands of dollars and, in some cases, tens of thousands of dollars. And if you lied about where you lived on your application or re-certification forms, you could face criminal charges.

Home and Asset Ownership: If you applied for Medicaid or Family Health Plus before 2010, then you were required to disclose if you owned or home or had other assets such as bank or investment accounts. Failing to disclose your assets, or understating their value, can constitute Medicaid eligibility fraud.

After 2010, your eligibility was determined only by looking at your monthly income. But the investigators still may want to know if you own a home. As mentioned above, your ability to pay a mortgage may raise questions about what your actual income is.

Employer Health Insurance: Your eligibility for Medicaid and Family Health Plus is also affected by your ability to obtain health insurance from your employer.

The application and re-certification forms for Medicaid and Family Health Plus ask whether you are able to obtain health insurance through your employer or your spouse’s employer. Providing a false answer to that question may constitute Medicaid eligibility fraud, even if you never actually received medical benefits from an employer.

Here’s the bottom line: Medicaid fraud is a serious offense. You could face lawsuits to recover money from you and even criminal charges. A letter from an investigator, therefore, should be taken seriously and should not be ignored.

To arrange a free and confidential consultation with an experienced Medicaid fraud attorney, call John Howley, Esq. at (212) 601-2728.

John Howley, Esq.

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John Howley, Esq.
The Howley Law Firm P.C.
350 Fifth Avenue, 59th Floor
New York, New York 10118
(212) 601-2728

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THIS BLOG PROVIDES GENERAL INFORMATION. IT DOES NOT PROVIDE LEGAL ADVICE. YOU SHOULD CONSULT A LAWYER TO OBTAIN LEGAL ADVICE REGARDING YOUR INDIVIDUAL SITUATION.

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