Medicaid Investigation Attorney in New York City
A Medicaid investigation can come from one of several agencies, and each has its own rules, its own evidence-gathering tools, and its own appetite for criminal referral. A Medicaid investigation attorney's job is to figure out which agency is in front of you, what it is actually after, and what gets said and produced before the matter hardens into a case. Call 212-233-1233 or email [email protected].
The Agencies We Respond To
- HRA Bureau of Fraud Investigation (BFI) — recipient-side, usually housed at 375 Pearl Street in Manhattan.
- Medicaid Fraud Control Unit (MFCU) of the New York State Attorney General — provider-side; has criminal jurisdiction.
- Office of the Medicaid Inspector General (OMIG) — audits, overpayment recoveries, corrective action.
- HHS Office of Inspector General (HHS-OIG) — federal share, administrative subpoenas.
- US Attorney's Office (SDNY / EDNY) — when the case is being grand-juried federally.
What We Do at Each Stage
First Contact
The first letter or subpoena is the cheapest place to fix problems. We file a notice of appearance so that future contact runs through us, not through you or your office staff. We get the scope of the inquiry on paper and pin down the deadlines.
Pre-Interview Investigation
We pull the Medicaid file, the wage data, the EBT/billing history, and (for providers) the patient charts and billing software. We map what the agency probably has against what is true and what is harmful. Decisions about interview, proffer, and document production come out of that map — not out of guessing.
Interview / Proffer
For recipients, we usually do not let the client sit for the BFI interview. For providers, an interview or proffer may make sense, especially if it can take the case off the criminal track. Either way, the choice is informed.
Document Production
Subpoenas to providers must be answered with a privilege log, a retention hold, and a culling process that preserves work product. Subpoenas to recipients usually ask for far more than is required. We narrow scope, produce in stages, and use the production to tell the favorable version of the story.
Negotiation and Resolution
Most investigations end short of indictment. A repayment agreement, a civil overpayment, a corporate integrity agreement, or a Disqualification Consent Agreement is often available where the case was lawyered early. We work toward those outcomes from the first call.
If You Are a Licensed Professional
A Medicaid investigation against a doctor, dentist, nurse, pharmacist, or other licensed professional has two parallel cases — the Medicaid investigation and the licensing case before OPMC, OPD, or the Board of Pharmacy. Reporting obligations and statements in one forum can damage the other. We coordinate both.
Do Not Try to Handle It Alone
Investigators are trained interrogators. They will be friendly, then strict, then friendly again. They will tell you that you can clear this up if you just answer a few questions, and that hiring a lawyer makes you look guilty. None of that is true. Hiring a lawyer makes you protected.
If you are under Medicaid investigation, call us at 212-233-1233 or email [email protected]. We are a private firm, not the government. Everything you say to us is confidential.
About the Author
Albert Goodwin Esq. is a licensed New York criminal defense attorney with over 18 years of courtroom experience in New York City. He can be reached at 212-233-1233 or [email protected].
