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Medicaid Fraud Agent Visited Me

March 21, 2024 Uncategorized

An unexpected visit from a Medicaid Fraud Agent can be a disturbing and intimidating experience for even the most experienced Medicaid providers. It is not uncommon for one or more agents to show up unannounced to your home or place of business, identify themselves and initiate an accusatory line of questioning before you have time to react thoughtfully. This visit can be initiated by a variety of sources or complainants, whether an investigation is actually warranted or not. Medicaid fraud investigations are not only aimed at Medicaid providers. Investigations are often initiated on Medicaid recipients, especially if a recent situation creates a red flag. Sometimes, the simple act of purchasing a new home or car can be enough to trigger an investigation. This will typically result in an unannounced visit by two or more investigators, armed with just enough documentation to scare you.

In a situation like this one, many individuals will let their guard down and speak to the investigator freely, naturally responding to any questions that they may have. After all, if you didn’t do anything wrong, what harm can answering a few questions possibly do, right? Fear and human emotion play a huge factor in investigative situations, especially during unscheduled visits. The additional pressure of wanting to avoid a scene at work or in front of family and friends is a powerful motivator and can make people say and do things that they will later regret. What many Medicaid providers don’t realize is that speaking to a Medicaid Fraud Investigator without an attorney can be fatal to their business, home, license and/or livelihood.

If you are visited by a Medicaid Fraud Investigator, it is imperative that you do not do or say anything that may put you, your family or your business in jeopardy. Protecting yourself by ensuring that you are properly represented is not a sign of guilt; rather it is protecting yourself from saying something that could be misconstrued and used against you later on. Even the most innocent of statements can be spun and escalated into a serious liability and leave you in a precarious position before the investigation even begins. Bear in mind the following while dealing with a fraud investigator:

  • Act calm and rational. Keep your tone low and avoid conflict as much as possible.
  • Ask the agents for proper identification and a business card at the onset of the visit
  • Request the nature of the visit and/or allegations.
  • Ask for copies of any paperwork that may be available at the time of the visit.
  • Do not make any statements or respond to any claims, no matter how outrageous they sound
  • Do not lie to the investigator. When in doubt, say nothing at all.
  • You do not have to answer any questions or provide any information immediately.
  • Be polite and courteous but firm at all points of the visit.
  • Do not hand over any files or records, even if requested by the agent.
  • Do not allow the seizure or photography of any documents or files without a warrant.
  • Let the investigator know that you will have your counsel contact them promptly.

One of the most frustrating aspects of a fraud investigation visit is the aftermath. In addition to being forced into dealing with deep allegations that carry stiff penalties, when given time to reflect, it can be frustrating to realize what an intimidating process it is. People showing up unannounced, wanting to rummage through your records and making accusations can be upsetting for even the most level-headed of folks. Penalties can easily range from fines to remediation, to loss of licensure or prison. These investigations are extremely serious matters that should never be treated lightly or undertaken by an unrepresented person. The fraud investigators hold tremendous power in their hands and should not be underestimated. They are given a tremendous amount of latitude by the state and Federal Government and are trained to use this to their advantage.

The majority of Medicaid Fraud Investigators play by the rules and do their job as required. However, some fraud investigators may employ unorthodox tactics to obtain inaccurate information to pad their file and validate their investigation. They can make outrageous accusations, twist allegations and put a negative spin on any responses that you make in order to suit their agenda. Some investigators will do the opposite and short-change an investigation, ignoring important facts to your disadvantage. This is why obtaining an experienced Medicaid Fraud Attorney is imperative and should be done immediately, usually within 24 hours of a visit. Our law firm is one of the most respected and experienced law firms in the industry. We specialize in the aggressive and zealous representation of our Medicare clients.

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