​New York Medicaid Fraud Control Unit

Did You Receive a Subpoena or Visit from the Medicaid Fraud Control Unit?

The Medicaid Fraud Control Unit is part of the New York State Attorney General's Office.  It conducts investigations of physicians, pharmacists, nurses, durable medical equipment companies, and other healthcare providers who are suspected of Medicaid fraud.

A Medicaid Fraud Control Unit investigation is a very serious matter.  Failure to respond properly could result in criminal charges, exclusion from the Medicaid program, and the suspension or revocation of your professional license.

If you received a subpoena or have been contacted by an Assistant Attorney General or investigator from the Medicaid Fraud Control Unit, you should consult with an experienced Medicaid fraud defense attorney immediately.  Call us today to schedule a consultation.

Call (212) 601-2728

Answers to Frequently Asked Questions (FAQ)
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​What is the Medicaid Fraud Control Unit?

The Medicaid Fraud Control Unit (“MFCU”) is the largest unit in the New York State Attorney General’s office.  It is part of the Criminal Division and is charged with investigating and prosecuting individuals and companies who engage in Medicaid fraud.  It has dozens of prosecutors, investigators, and auditors throughout New York State, including at offices in Manhattan and on Long Island.
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The auditors, investigators, and prosecutors in the Medicaid Fraud Control Unit focus on investigating hospitals, nursing homes, pharmacies, doctors, dentists, nurses, and other healthcare providers that submit false or fraudulent claims to the New York State Medicaid Program.

​What does the Medicaid Fraud Control Unit investigate?

The Medicaid Fraud Control Unit targets individuals and companies that engage in overbilling, kickbacks, double-billing, upcoding, fraudulent prescriptions, substandard drugs and medical equipment, and abuse and neglect in nursing homes and other health care facilities.

The Medicaid Fraud Control Unit has the authority to bring criminal charges against those who engage in Medicaid fraud.   It can also commence civil lawsuits and asset forfeiture actions to recover money.  Whether an investigation will turn into criminal charges often depends on how you respond.

​Why am I being investigated?

Most Medicaid Fraud Control Unit investigations begin because of a referral from another agency, such as the New York State Office of the Medicaid Inspector General (OMIG) or the New York State Department of Health.  The government uses sophisticated data analytics to identify possible fraud.  Once an unusual pattern is identified, government auditors will review medical and billing records.  Investigators will speak with patients, current and former employees, and anyone else who might have useful information.  If the government believes a crime has been committed, it will refer the matter to the Medicaid Fraud Control Unit.

Other investigations begin because of a whistleblower complaint.  Whistleblowers can be patients, current or former employees, competitors, consultants, or anyone else who comes forward with evidence of possible Medicare and Medicaid fraud.

​What should I do when investigators come to my office?

Do not talk to investigators from the Medicaid Fraud Control Unit or any other government agency without your lawyer.  Politely tell the investigators that you cannot talk now, ask for their business card, and tell them that you or your lawyer will get back to them.  Then contact us immediately.

A Medicaid Fraud Control Unit investigation can have serious consequences.  It can result in criminal charges, exclusion from the Medicaid program, hundreds of thousands of dollars in restitution, fines and penalties, and the loss or suspension of your professional license.  

Do not say anything to the investigators until you have consulted with an experienced Medicaid fraud lawyer and developed a strategy for protecting your rights.

How should I respond to a subpoena from the Medicaid Fraud Control Unit?

​A subpoena from the New York Medicaid Fraud Control Unit is a very serious matter.  It means that a prosecutor already suspects that you have committed Medicaid fraud.  The subpoena is one of the tools they will use to build a case against you.  One wrong step could result in serious criminal charges that can destroy your career.

Do not try to handle this on your own.  Contact one of our experienced Medicaid fraud defense lawyers immediately.  We will contact the prosecutor or investigator in charge of the investigation to determine if you are a target or a witness.

We will review the subpoena to determine if it can be challenged.  If you must produce documents, then we will determine exactly which documents must be produced.  For example, the Medicaid Fraud Control Unit may only request medical records of Medicaid recipients.  They are not entitled to records of patients with other forms of insurance without the patient’s consent.

We will arrange for documents to be copied and numbered so we can keep track of what is produced to the government.  Then we will turn over copies – not the originals – to the Medicaid Fraud Control Unit.  You are entitled to retain your original patient records, and you will need them to continue your practice.
We will review and analyze the documents to help you understand why you are being investigated. 

We will speak directly with investigators and prosecutors to understand the strengths and weaknesses of their case.  This is critical information that you cannot get on your own.  We will use this information to develop your defenses and help you understand your options.

Medicaid fraud is a highly specialized area of the law.  You need a lawyer who understands the laws, rules, and regulations that govern Medicaid.  He must be familiar with medical terms and how a medical practice operates.  He must also be an experienced criminal defense lawyer.  Very few lawyers have experience in all of these areas.

What are my rights during the investigation?

You have the right to bring an attorney with you to any interviews or meetings with the investigator.  You also have the right to consult with your lawyer before providing any documents or answering any questions.

You have the right to remain silent.  You do not have to answer the investigator's questions.  If you are a Medicaid recipient, your benefits cannot be stopped solely because you refused to answer questions.  And if you have an attorney, you may not have to meet with the investigator or answer any of their questions.

Should I cooperate with Medicaid Fraud Control Unit investigators?

How you respond to the investigation depends on your particular facts and circumstances.  Some questions and requests for documents are appropriate.  Others may be improper.  Sometimes it makes sense to cooperate with the prosecutor and investigators to negotiate a resolution.  Other times you must fight to protect your rights.

You need expert advice from a Medicaid defense lawyer to make those decisions.
  
Your lawyer needs to understand all the facts and circumstances before advising you whether or not to cooperate.  In order to do that your lawyer needs to speak with the prosecutor or investigators to understand what they think you did wrong, what evidence they have against you, and what they intend to do.  Your lawyer also needs to speak with you and review your documents to help you prepare a response and defense to potential charges.

If you and your lawyer agree to cooperate, your lawyer will negotiate with the prosecutor and investigators to make sure your rights are protected.  For example, your lawyer may negotiate a formal, written “proffer” agreement, where you will agree to tell your side of the story, and the prosecutor will agree not to use anything you say against you as long as you tell the truth.

What are the possible penalties and consequences of a Medicaid Fraud Control Unit investigation?

Medicaid fraud penalties range from repayment of Medicaid benefits to harsh prison sentences.  Some of the possible consequences are:

• monetary fines, penalties, and restitution orders
• disqualification or exclusion from receiving Medicaid benefits
• civil judgments and liens on any real property you own
• garnishment of your wages
• criminal prosecution and a possible prison sentence
• suspension or loss of professional licenses
• exclusion from participating in Medicaid as a healthcare provider
• depending on your immigration status, you could be deported

​Who conducts the investigations at the Medicaid Fraud Control Unit?

Investigations at the Medicaid Fraud Control Unit are assigned to teams that include a prosecutor, one or more investigators, and one or more auditors.  The prosecutors are Assistant Attorneys General who specialize in Medicaid fraud.  The investigators are almost always former police detectives.  The auditors are specially trained to investigate healthcare fraud.

The people investigating you are trained professionals.  many of them have 10, 20, and even 30 years of experience investigating thousands of Medicaid fraud cases.  They are supported by data analysts, financial auditors, and medical experts.
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Do not try to handle this on your own.  Get an experienced Medicaid fraud attorney on your side to protect your rights.

​Will the Medicaid Fraud Control Unit negotiate a settlement?

​Depending on the nature of the problem, the investigator may be willing to negotiate a financial settlement to avoid any court cases or criminal prosecution.  An experienced Medicaid fraud attorney can help you by negotiating a settlement that reduces the amount owed, by avoiding penalties and interest and, most importantly, by negotiating an agreement that your case will not be referred for criminal prosecution.

​When do Medicaid fraud investigations result in criminal charges?

The government conducts healthcare fraud investigations literally every day.  In many cases, an experienced attorney can help you negotiate a financial settlement to resolve allegations of questionable or false claims.  In more serious cases, the government may insist on a guilty plea but will agree to a sentence of probation.

Sometimes, however, the government pursues criminal charges and a sentence of five or ten years in prison.  A key factor is the nature of the false or fraudulent claims.  Conduct that is obviously intentional, that involves numerous false claims over a long period of time, or that has put patient safety at risk is more likely to result in criminal charges.

Another critical factor is how you respond to the audit or investigation.  If the prosecutor or investigators believe that you are not telling the truth, or that you are trying to obstruct their investigation, they are more likely to pursue criminal charges.  That is another reason why you need a professional on your side.  Your lawyer can speak directly to the prosecutor and investigators in ways you cannot.

You should consult with an experienced Medicare and Medicaid fraud attorney immediately, before you say anything to investigators.  You have very important legal rights during an investigation.  You have the right to consult with a lawyer.  You have the right to have your lawyer present during any meetings or interviews with investigators.  You have the right to remain silent and to refuse to answer the investigators’ questions.

An experienced Medicaid and Medicare fraud lawyer can help you understand the possible charges and consequences, develop a strong and aggressive defense, negotiate with the government to avoid or reduce the charges and penalties, and, if necessary provide an aggressive defnse at trial.

​How can an experienced Medicaid fraud defense lawyer help me?

Your Medicaid defense lawyer can talk to investigators and prosecutors in ways you cannot.  We can find out why they are investigating you, what evidence they think they have against you, and what questions they want to ask you.  That is critical information you need to know before you even think about talking to them.

You Medicaid defense lawyer can help you identify which documents should and should not be turned over to investigators.  Some documents must be produced, while others may be withheld.  We will help you make those decisions, handle any document production to protect your rights, and create a record of everything that is turned over.

Most of all, your Medicaid defense lawyer will help you develop a strategy and the evidence you need to protect your rights.  This includes advising you whether or not to speak with investigators.  And if it makes sense for you to speak with prosecutors or investigators, we will prepare you thoroughly and be by your side the entire time.

Get an Experienced Medicaid Defense Lawyer on Your Side

Call (212) 601-2728