Health & Disability

What You Need to Know About Medicaid Overpayment Investigations in NYC

Before the Covid-19 pandemic, anyone who got Medicaid benefits in New York City could be investigated for their past or present eligibility for Medicaid. These investigations usually started with a letter from the NYC Human Resources Administration (HRA) asking for information about your household and finances. If HRA decided that you were not eligible for Medicaid for a period of time, they would ask you to sign a contract agreeing to pay back the Medicaid “overpayment.” The overpayment is the cost of your Medicaid coverage during that time.

If you did not sign a settlement agreement, HRA would send your case to a law firm (most likely Linebarger Goggan Blair & Sampson, LLP, or Leopold Gross & Sommers PC). The law firm would then try to settle the case with you. If you did not settle the case, the law firm might have then sued you in court.

Now, in New York City, people who signed a settlement agreeing to pay back a Medicaid overpayment do not have to make any more payments on that agreement. But, if you have a court-ordered judgment, this new policy does not apply to you. You must continue to follow the judge’s order.

How do I know if I signed a settlement agreement or if there is a judgment against me?

A settlement is an agreement between parties. Settlements can be made outside of court without a judge, or they can be made during a court case and approved by a judge. In a settlement, judges do not decide the case by hearing all the facts and law. Instead, they allow the parties to come to an agreement on their own. Settlement agreements that are approved by a judge include the words “so ordered” in the agreement.

A judgment is a decision that must be made by a judge during a court case. Some cases end in “default judgments.” In these cases, this means that HRA automatically wins because the person with Medicaid never responded to the court papers or appeared in court. Sometimes this happens because the person with Medicaid did not get the right paperwork to tell them about the lawsuit.

To identify a judgment, look for the word “judgment” in your court papers. The court papers sometimes use the words “so ordered and adjudged” “civil judgment” or “judgment entered.” If you can’t tell if there is a judgment against you, you can call the clerk of the court that handled your case. The name of the court will be on your paperwork. It should say either Supreme Court or Civil Court. You can call the court and ask for the clerk’s office.

As of this writing on March 15, 2024, HRA is reviewing all cases to figure out which ones were judgments. If you have a judgment, you will be contacted by the law firm that is handling the case telling you that it’s time to start paying again.

I have not had to make payments on my settlement agreement in a few years. Do I have to start again?

During the COVID-19 emergency, HRA paused all investigations, court cases and collections for Medicaid overpayments. Medicaid overpayment court cases and collections are not paused anymore. Therefore, if there is a judgment against you, you will need to make payments again. If there was a judgment in your Medicaid overpayment case, you will be contacted by the law firm that handles the case.

If you signed a settlement agreement and there was no judgment against you, you do not need to make any further payments to satisfy that agreement. If this is the case, HRA or the law firm you made a settlement agreement with will send you a letter telling you that don’t have to make any more payments.

Before the COVID-19 emergency I was in the middle of a Medicaid overpayment investigation by HRA.

If you were in the middle of a Medicaid overpayment investigation before the COVID-19 emergency started and the investigation was not in court, HRA investigators will not be contacting you.

But HRA can tell a law firm who represents them to sue you in court. If you are sued in court, you must get notice of the lawsuit. Please pay attention to your mail.

Before the COVID-19 emergency a law firm was trying to collect a Medicaid overpayment from me.

If before the COVID-19 emergency, a law firm representing HRA contacted you to try to collect a debt for a Medicaid overpayment and they did not sue you in court, HRA will stop trying to collect for that.

But HRA can direct a law firm who represents them to sue you in court. If you are sued in court, you will likely be notified by mail. Please pay attention to your mail.

Before the COVID-19 emergency I was sued in court for a Medicaid overpayment.

Medicaid overpayment lawsuits may continue. You should pay attention to your mail. You may have to answer or file other papers and/or appear in court.

I already made payments on a Medicaid overpayment settlement agreement that I signed. Will I get my money back?

Unfortunately, you will not be paid back any money you already paid on a settlement agreement for a Medicaid overpayment.

Will I get anything from HRA or the law firms representing HRA telling me about this new policy?

Yes.

If you signed a settlement agreement with HRA, or with a law firm representing HRA, you will get a letter telling you that HRA or the firm will no longer try to collect any money from you.

If there was a judgment in your Medicaid overpayment case, you will be contacted by the law firm that handles the case.

Is HRA still allowed to evaluate my Medicaid eligibility or refer me to local law enforcement for Medicaid fraud?

HRA may look into your Medicaid eligibility and they may send you requests for additional information. If HRA finds that you are not eligible for Medicaid, they can only close your Medicaid case by sending you a written notice and giving you a chance to ask for a fair hearing.

HRA can also continue to refer cases of possible Medicaid fraud to local law enforcement. You can be ordered to repay Medicaid benefit as part of a criminal sentence. This is very uncommon and only a tiny fraction of Medicaid investigations result in criminal investigations.

Disclaimer

The information in this document has been prepared by The Legal Aid Society for informational purposes only and is not legal advice. This information is not intended to create, and receipt of it does not constitute, an attorney-client relationship. You should not act upon any information without retaining professional legal counsel.

Last Updated: 15 April

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