NYC Medicaid Fraud Lawyers

| by Max Soni

Last Updated on: 5th October 2025, 10:43 am

New York Medicaid Fraud Defense – The HRA Letter Means They Already Know

When the Human Resources Administration letter arrives requesting an “interview” about your Medicaid benefits, they’ve already run your Social Security number through the Asset Verification System, which accesses financial data from 49 states’ banking systems, the IRS, state tax departments, DMV records, and real property databases nationwide. The AVS found that $2,000 you inherited from your aunt in Ohio, the used car you bought but registered in New Jersey, and the part-time 1099 income you thought wasn’t reportable. The HRA spent 50-100 hours building their case before sending that letter. The “interview” isn’t investigation – it’s confession extraction. They know the answers to every question they’ll ask. They’re recording everything, waiting for you to lie about something they can already prove, turning welfare fraud into welfare fraud plus perjury under NY Penal Law § 175.30.

The dollar amount you allegedly received improperly determines whether you face misdemeanor or felony charges. Under NY Penal Law § 158:

• Under $1,000: Welfare fraud 5th degree (Class A misdemeanor, up to 1 year)
• $1,000-$3,000: Welfare fraud 4th degree (Class E felony, up to 4 years)
• $3,000-$5,000: Welfare fraud 3rd degree (Class D felony, up to 7 years)
• $5,000-$50,000: Welfare fraud 2nd degree (Class C felony, up to 15 years)
• Over $50,000: Welfare fraud 1st degree (Class B felony, up to 25 years)

These amounts include ALL benefits received during the fraud period – Medicaid, SNAP, cash assistance. Five years of unreported income earning you $2,000 in improper Medicaid benefits triggers automatic felony charges.

The Asset Verification System Sees Everything

AVS is a data-matching consortium between federal and state agencies that NY uses to verify Medicaid eligibility. It accesses:

• Bank accounts nationwide (including closed accounts from past 5 years)
• Investment accounts (stocks, bonds, mutual funds, cryptocurrency exchanges)
• Real property in all 50 states
• Vehicle registrations nationwide
• Life insurance policies with cash value
• Pension and retirement accounts
• IRS tax records (including unfiled years)
• State tax records from all states you’ve lived in
• Social Security Administration earnings records

You didn’t report the $5,000 CD your grandmother left you in Florida? AVS found it. The motorcycle registered in Pennsylvania? Found. The Uber driving income you thought was under reporting thresholds? IRS Form 1099-K already shared with HRA. The system runs quarterly matches, flagging discrepancies for investigation.

Provider Fraud vs Recipient Fraud – Guess Who Goes to Prison

Medicaid providers (doctors, clinics, pharmacies) steal millions through billing fraud, but get civil settlements and keep practicing. Recipients who fail to report $2,000 in income face criminal prosecution. The disparity is systemic:

Provider Fraud Resolution:

• Civil False Claims Act settlement
• No admission of wrongdoing
• Payment plan over years
• Keep medical license
• Continue billing Medicaid

Recipient Fraud Prosecution:

• Criminal charges filed immediately
• Arrested at home or work
• Permanent Medicaid disqualification
• Full restitution demanded immediately
• Immigration consequences
• Employment termination

A doctor who bills $500,000 in false claims pays $750,000 over 5 years and keeps practicing. A home health aide who didn’t report overtime earnings owes $3,000, gets arrested, loses her job, and faces deportation. The Office of Medicaid Inspector General (OMIG) has different units – providers get “compliance reviews,” recipients get criminal investigators.

The Five-Year Lookback That Destroys Lives

NY can prosecute Medicaid fraud going back five years under the statute of limitations. But Medicaid eligibility reviews can examine your entire benefit history. They’ll find:

• That inheritance from 2019 you forgot about
• The personal injury settlement from 2020
• Unemployment benefits during COVID you didn’t report
• Cash jobs from 2021-2022
• The car accident settlement from 2018

Each unreported asset or income source becomes a separate count of welfare fraud. Five years of allegations stack into dozens of felony counts. Prosecutors charge each month of improper benefits separately, turning one mistake into 60 criminal counts.

Immigration Catastrophe from Any Conviction

Welfare fraud is a deportable offense under IRS § 237(a)(2)(A)(ii) as a crime involving moral turpitude. Even misdemeanor convictions trigger removal proceedings for:

• Green card holders (lawful permanent residents)
• Visa holders (students, workers)
• Asylum seekers
• DACA recipients

ICE has access to NY criminal databases. Conviction triggers automatic immigration review. The Medicaid you used during the five-year waiting period for green card eligibility now disqualifies you from citizenship forever. That emergency Medicaid for your child’s broken arm becomes grounds for family separation.

Professional License Annihilation

NY automatically reports Medicaid fraud convictions to professional licensing boards:

• Nurses lose RN licenses
• Home health aides banned from healthcare employment
• Teachers lose certification
• Real estate agents lose licenses
• Security guards lose permits
• Taxi/Uber drivers lose TLC licenses

The conviction doesn’t need to relate to your profession. A teacher who didn’t report summer income loses teaching certification. A nurse who made an innocent mistake on her renewal application can never work in healthcare again. These are lifetime bans in many cases, destroying careers over paperwork errors.

HRA’s Investigation Powers

HRA investigators aren’t police but have extensive authority:

• Access all government databases without warrants
• Contact employers directly
• Interview neighbors and family
• Surveillance of your residence
• Review social media accounts
• Subpoena bank records
• Coordinate with ICE

They build cases for 6-12 months before contacting you. That friendly letter is the culmination of extensive investigation, not the beginning. They’ve already:

• Verified your employment through Department of Labor
• Checked property records in surrounding states
• Reviewed five years of tax records
• Interviewed your landlord
• Surveilled your residence to verify household composition

The Interview Trap

The HRA interview invitation seems optional. It’s not. Refusing creates inference of guilt used at trial. Attending without an attorney is worse. The interview is:

• Recorded (audio and video)
• Under oath (perjury charges apply)
• No Miranda warnings (not custodial interrogation)
• No right to remain silent without consequences
• Used as evidence in criminal trial

Questions seem innocent but are carefully scripted:

• “Who lives with you?” (They already know from surveillance)
• “Any other income?” (They have your tax records)
• “Own any vehicles?” (DMV already provided registration)
• “Any bank accounts?” (AVS found all accounts nationwide)

Each lie becomes a separate felony under NY Penal Law § 175.30 (offering a false instrument). The welfare fraud charges might be defensible, but lying during the interview creates new crimes with mandatory prosecution.

Parallel Civil and Criminal Proceedings

Medicaid fraud triggers simultaneous actions:

Civil Recovery:

• OMIG issues overpayment determination
• No right to counsel
• Preponderance of evidence standard
• Administrative hearing with biased judges
• Immediate asset freezing
• Wage garnishment before conviction

Criminal Prosecution:

• DA files criminal charges
• Right to counsel (if you qualify/can afford)
• Beyond reasonable doubt standard
• Jury trial possible
• Prison sentence potential
• Permanent record

The civil case proceeds faster, creating admissions used in criminal prosecution. You can’t invoke Fifth Amendment in civil proceedings without adverse inference. Everything you say in civil proceedings becomes evidence in criminal case. You’re defending two cases with conflicting strategies.

Call Now – The AVS Runs Again Tomorrow

212-300-5196

The Asset Verification System runs quarterly matches, but special investigations run daily. Every day you wait, more data accumulates. That new job you started last week already reported to Department of Labor. The insurance settlement from your car accident hit your bank account, triggering AVS alerts. Your cousin added you to their lease, changing your household composition.

If you received the HRA letter, you have 10 days to respond. Miss that deadline, they proceed with criminal referral based on existing evidence. Attend without an attorney, you’ll create new crimes through false statements. The interview is scheduled, the investigator prepared, the case already built.

Medicaid estate recovery means even death doesn’t end liability. Your family inherits the debt. Liens attach to property. Life insurance proceeds get seized. The government pursues your estate for every dollar of benefits received after age 55.