How to Prepare Before Responding to a Medicaid Fraud Investigation

One of the biggest mistakes you can make in a Medicaid fraud investigation is to meet with the investigators before you have thought through your defenses.

Merely denying the investigator’s allegations will not convince them to go away.  You must have a strategy for convincing them not to charge you with a crime.  This strategy should include both legal challenges and challenges based on the evidence.

The starting point is getting an objective understanding of the facts, including any mistakes you may have made.  Sometimes clients had no intent to commit Medicaid fraud, but mistakes were made.  You need an objective look at your records and an understanding of where things may have gone wrong.  Once you understand where the problems are, you can begin to build your defense.

You also need to understand the evidence against you.  Do the investigators have documents or witnesses that they intend to use against you?  What are those documents and who are those witnesses?  Are there other documents that will contradict the evidence that the government thinks it has against you? 

You need to think through all the evidence the government may have before you respond to the investigators’ questions.  The investigators will not give this information to you.  But an experienced Medicaid fraud lawyer can often figure out the investigators' concerns by talking with them before they get a chance to ask you any questions.

You have a constitutional right to remain silent and to require the government to prove its case beyond a reasonable doubt.  If, after conducting a review of your records, it appears that you have serious problems, your lawyer may recommend that you exercise those rights.

On the other hand, if the review of your records reveals that the government is mistaken or that there are weaknesses in its case, then your lawyer may advise you to produce evidence to raise doubts about the strength of the government’s case against you. 

Your lawyer may also decide to have you speak with the investigators under a procedure called a proffer.  A proffer allows you to tell your side of the story, but prevents the government from using your statements against you as long as you tell the truth..

For example, if you are accused of making false statements, you may be able to avoid criminal charges by giving the investigators evidence that the statements were true when they were made, or that you believed the statements to be true when they were made, or that any problems with the statements were the result of a mistake and not an intentional attempt to defraud the government.

Medicaid fraud investigations are not always black and white.  There are often gray areas where the government will be willing to negotiate a resolution without going to court.  You need to have a complete understanding of your case – and a complete understanding of what the government may and may not do – in order to prepare your defense.

The bottom line is:  Do not rush into responding to a Medicaid fraud investigation.  An effective defense requires a thoughtful strategy based on the law and the evidence.

For more tips on how to respond to a Medicaid fraud investigation, download our free report, "5 Deadly Mistakes in Medicaid Fraud Investigations."  Just click here to download a free copy.

Then call an experienced Medicaid fraud defense lawyer to discuss the specifics of your case.  To schedule a free and confidential consultation, call us at (212) 601-2728.

John Howley, Esq.
The Howley Law Firm P.C.
350 Fifth Avenue, 59th Floor
New York, New York 10118
(212) 601-2728