Received a Medicaid Investigation Letter in New York City
A Medicaid investigation letter in New York City can come from several different agencies, depending on whether you are a recipient, a provider, or both: the Human Resources Administration (HRA) Bureau of Fraud Investigation, the Medicaid Fraud Control Unit (MFCU) of the Office of the Attorney General, the Office of the Medicaid Inspector General (OMIG), or HHS-OIG on the federal side. Each runs a different process. None of them sends letters lightly.
Whatever the letterhead says, the rule is the same: do not call the investigator. Call us first at 212-233-1233 or email [email protected]. The consultation is free and confidential by law.
Who Sent the Letter and What It Means
HRA Bureau of Fraud Investigation
If the letter comes from HRA or the Bureau of Fraud Investigation — often at 375 Pearl Street — the investigation is into recipient-side Medicaid issues: unreported income, unreported household members (frequently a spouse or partner whose income would have changed eligibility), or assets that were not disclosed at application or recertification.
Medicaid Fraud Control Unit (OAG)
The MFCU sits in the Office of the Attorney General and handles provider-side Medicaid cases. An MFCU letter or subpoena to a doctor, dentist, pharmacy, home-care agency, DME supplier, or behavioral-health provider signals a serious investigation that can lead to indictment, civil False Claims Act exposure, and exclusion from Medicaid.
Office of the Medicaid Inspector General (OMIG)
OMIG conducts audits, recoups overpayments, and refers matters to MFCU when criminal exposure appears. OMIG audit demands and information requests should be answered by counsel.
HHS-OIG (Federal)
When the federal share is implicated, HHS-OIG may issue an administrative subpoena under 5 U.S.C. App. § 6(a)(4). These investigations sometimes run alongside US Attorney grand jury subpoenas in the SDNY or EDNY.
What the Agency Already Has
By the time the letter is sent, investigators have typically pulled:
- Medicaid application and recertification paperwork
- Wage records from the Department of Labor and the IRS
- Bank statements obtained by subpoena
- Utility, vehicle, and tax records suggesting household composition
- For providers: billing data, patient charts, prescription histories, and (often) statements from former employees
What to Do Now
- Save the letter. Photograph the envelope, the postmark, and the contents. Note the investigator's name and the response deadline.
- Do not call. Not to schedule, not to ask questions, not to explain.
- Do not produce documents until counsel has reviewed the request and screened for privilege.
- Do not talk to family or coworkers about the case. Statements to third parties are not privileged.
- If you are a licensed professional, do not self-report yet — reporting decisions should be coordinated with criminal strategy.
- Call counsel before the deadline. A short letter from counsel often buys time and changes the tone of the investigation.
What Can Happen Next
- Civil overpayment. Most recipient cases settle here with a repayment plan.
- Administrative disqualification. An IPV-like hearing for recipients; corrective-action plans or exclusion for providers.
- Criminal prosecution. Welfare fraud (PL Article 158), grand larceny (PL Article 155), offering a false instrument (PL Article 175), and on the federal side healthcare fraud (18 U.S.C. § 1347).
If you received a Medicaid investigation letter, call us at 212-233-1233 or email [email protected].
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].
