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Medicaid Fraud investigation New York

Discussion in 'Health Insurance, HMO, HIPAA & Disability' started by lyle12, Oct 14, 2018.

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  1. lyle12

    lyle12 Law Topic Starter New Member

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    Jurisdiction:
    New York
    I was working until the end of 2013 when I was laid off. I applied for New York State Health Insurance Medicaid and I was given free health insurance.

    Since then, I've looked for work, tried to start my own business (failed) and eventually renovated my home and bought another investment property which I am currently renovating.

    I have applied and successfully received medicaid for 2014 - current.

    I recently received a letter from NYS Social Services Fraud Division and they want to meet with me. They are requesting my tax returns, mortgage documents, rental income history (have not received any rental income) and pay stubs (non-existent).

    I'm a little concerned.

    Any advice on how I should proceed?

    Thanks.
     
  2. army judge

    army judge Super Moderator

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    You might want to retain an attorney.

    I think you know why, as well as what, the authorities wish to discuss.
     
    lyle12 likes this.
  3. lyle12

    lyle12 Law Topic Starter New Member

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    That's what I'm not clear on. Feel free to be explicit on what the authorities want to discuss. I have zero income.
     
  4. army judge

    army judge Super Moderator

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    How did you get the money, money, money, to do those wonderful things, while obtaining publicly funded health insurance?


    Yes, you SHOULD be concerned.

    The state could consider the benefits you've received for 4-5 years as FRAUD,

    Dude, you own a home (or are buying one), PLUS investment properties.

    If you can't connect the dots that would arouse the curiosities of the DEEP STATE, perhaps when you HIRE a lawyer, he or she can assist your memory.
     
  5. flyingron

    flyingron Active Member

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    I agree with ArmyJudge. Just being unemployed is nowhere near sufficient for qualifying for NY Medicaid. You misrepresented something in order to obtain benefits.
     
  6. shrinkmaster

    shrinkmaster Well-Known Member

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    When you apply for medicaid you fill out forms. The info requested is required to see if you qualify. If you do not include all assets and income The state can take legal action. Based on your post you lied or hid assets and/or income from state.
     
  7. lyle12

    lyle12 Law Topic Starter New Member

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    I had no income but I did have assets to pay for my investments and renovations. They come from my savings.

    The ACA (the Affordable Care Act) did away with asset tests.

    See pages 7-8 of this summary of the ACA. Section header: "Changes in Methodology for Medicaid Eligibility Determination "

    "Removal of Asset Test for Certain Eligibility Categories ƒ Requires states to use a net income standard (no asset or resource test, no income disregards) to determine eligibility"

    PDF: Wayback Machine

    Here is a NYS health Doc stating 2018 did not require an asset test. There is a link at the bottom for rules for years 2014-2017.

    Income and Resource Limits for New York State Public Health Insurance Programs - New York Health Access

    There maybe some home equity limitations... I am reading up on that.
     
    Last edited: Oct 14, 2018
  8. flyingron

    flyingron Active Member

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    Rent is income. Profit from investments is income.
     
  9. branimal

    branimal Member

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    I did not collect any rent. Profits need to be realized (sale at a gain) to be considered income.


    Sent from my iPhone using Tapatalk
     
  10. army judge

    army judge Super Moderator

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    Mate, no one this website will have any involvement in your issue with the state authorities.

    Whatever anyone tells you, you can accept or ignore it.

    This thread has served its purpose.

    Responders have given you their thoughts, now I will wish you well.

    Don't open it again under your @lyle12 ID or your @branimal ID; which violate our rules.

    For the moment, I'll overlook your transgression here, maybe the state will do the same.

    This thread is closed.............................................................
     

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