Getting a cease and desist letter from the New York State Medicaid Fraud Control Unit (MFCU) can feel alarming—especially if it accuses you of improper marketing, referrals, billing practices, or Medicaid-related fraud or abuse.
If you receive a cease and desist letter, you should immediately contact an attorney experienced in defending providers investigated by MFCU. A cease and desist letter may demand that you stop certain conduct and preserve documents. It is often a sign that the government is scrutinizing your business, license, or billing practices and may be considering bringing a civil action or criminal charges against you.
What Is the New York Medicaid Fraud Control Unit (MFCU)?
MFCU is a government enforcement unit that investigates and prosecutes certain types of Medicaid-related misconduct. Any provider reimbursed by Medicaid—including doctors, nursing homes, transportation services, and physical therapists—may be investigated by MFCU.
Depending on the circumstances, MFCU investigations can lead to:
- Administrative actions (such as actions against a provider’s license or disenrollment from Medicaid)
- Civil enforcement actions
- Criminal prosecutions
What Is a “Cease and Desist” Letter From MFCU?
A cease and desist letter generally alleges that the recipient has engaged in conduct MFCU believes is improper or unlawful and demands that the conduct stop. The letter may:
- Identify specific statements, advertisements, outreach methods, referral relationships, or billing practices MFCU considers problematic
- Demand immediate cessation of certain conduct
- Request or require a written response by a deadline
- Warn of escalating consequences if the conduct continues
- Put you on notice to preserve documents and communications
Even if a cease and desist letter is not a formal court order, ignoring it can significantly increase your risk.
What To Do Immediately If You Receive an MFCU Cease and Desist Letter
1) Get legal advice from counsel familiar with Medicaid enforcement
MFCU letters often involve Medicaid compliance issues, fraud allegations, licensing concerns, and sometimes parallel investigations. The best outcomes typically result from early, coordinated action.
2) Preserve documents and communications
Preserve anything related to the allegations, including:
- Medical records
- Patient or client intake records
- Billing records and supporting documentation
- Emails, text messages, chat messages, and internal memoranda
- Contracts and referral agreements
- Marketing materials (web pages, landing pages, flyers, social media posts, call scripts)
Do not delete or alter anything. If your organization has a document retention policy, consider implementing a litigation hold where appropriate.
3) Do not contact MFCU yourself without legal guidance
Before contacting MFCU or providing documents, it is often advisable to have counsel evaluate:
- What MFCU is actually alleging
- Whether the letter suggests a broader investigation
- Your potential exposure (civil, administrative, or criminal)
- How to respond without increasing your risk
What Happens After an MFCU Cease and Desist Letter?
Every case is different, but early coordination with an attorney can help reduce the risk of more serious consequences. A lawyer may recommend:
- Preparing a written response to MFCU
- Halting or modifying current business practices
- Gathering and reviewing relevant records
- Negotiating repayment of improperly received reimbursements to reduce potential civil penalties or avoid criminal charges
A well-planned response can sometimes narrow the issues, correct misunderstandings, and reduce the likelihood of escalation.
How a Lawyer Can Help With an MFCU Cease and Desist Letter
Legal counsel can help you:
- Analyze the letter and the legal theories behind it
- Assess immediate risk (civil, administrative, or criminal exposure)
- Identify errors or incorrect assumptions made by MFCU
- Prepare a strategic response
- Negotiate repayment amounts to mitigate monetary exposure and reduce the risk of civil fines or criminal charges
- Communicate with MFCU on your behalf
- Organize documents and implement compliance measures
- Advise on remediation, training, and policy improvements
If You’re a Provider or Business Owner: Get Help Before This Escalates
If you have received a cease and desist letter from the New York Medicaid Fraud Control Unit (MFCU), we can help. Our office has successfully negotiated with MFCU to prevent criminal charges, avoid civil fines, create structured payment plans, and narrow the scope of required reimbursement.
Contact ZMO Law PLLC to discuss your situation confidentially. Call: (212) 685-0999
Frequently Asked Questions (FAQ)
Is a cease and desist letter from MFCU the same as being charged with a crime?
No. A cease and desist letter means MFCU believes you may be violating the law or Medicaid regulations. It does not mean formal charges have been filed. However, it may indicate that criminal charges are being considered.
Should I comply immediately?
You should take the letter seriously, preserve records, and avoid continuing any questionable conduct. However, you should avoid making admissions or submitting a response without first speaking to an attorney.
Can I call MFCU to explain?
It is very risky to do so without counsel. Even well-intentioned explanations can create statements that may later be used against you.
What if the letter is wrong or based on misinformation?
That can happen. A carefully prepared, documented response—often through counsel—can sometimes correct the record and narrow the issues.
Disclaimer
This webpage is for general informational purposes only and does not create an attorney-client relationship. Laws and procedures may change, and outcomes depend on the specific facts of each case. If you need advice about your situation, contact an attorney. Prior results do not guarantee a similar outcome.