New York City Medicaid Fraud Lawyer

The Medicaid system in New York City provides essential medical care and prescription drugs to people in need. Because this system affects thousands every day, local law enforcement takes the administration of Medicaid extremely seriously.

Allegations of health care fraud are serious matters, and charges may range in severity from misdemeanors to harsh felonies. To prove fraud, a prosecutor must demonstrate not only a theft by deception but also that a defendant intended to commit this deceptive act.

Our New York City Medicaid fraud lawyers are ready to advocate on your behalf if you are facing allegations of fraudulent actions regarding your health care. Our strong defense attorneys can evaluate the strength of a prosecutor’s case, and prepare a case that protects your rights in and out of court.

What is a Criminal Diversion Act?

As all top New York City Medicaid Fraud lawyers know, the first step to presenting a strong defense in a criminal case – whether state or federal – is to know and understand the elements or factual requirements for the successful prosecution of the crime. For the offense of Criminal Diversion of Prescriptions, state prosecutors must prove at trial that the defendant knowingly performed what is known as a Criminal Diversion Act. This element is specifically defined in New York Penal Law § 178.00 (3), (a) – (d). These four subsections require the prosecution to prove at trial that a defendant knowingly:

  • Transferred or delivered, in exchange for anything of pecuniary value, prescription medication or device with the knowledge or reasonable grounds to know that the recipient has no medical need for it; or
  • Received, in exchange for anything of pecuniary value, prescription medication or device with the knowledge or reasonable grounds to know that the seller or transferor is not authorized by law to sell or transfer such prescription medication or device; or
  • Transferred or delivered a prescription in exchange for of pecuniary value; or
  • Received a prescription in exchange for anything of pecuniary value.

Under the statute, a “prescription medication or device” can be “any article for which a prescription is required in order to be lawfully sold, delivered or distributed.” NY Penal Law § 178.00 (1). What is clear at this point is that this provision covers more than just drugs considered controlled substances under state law; with one court only requiring that prosecutors prove the drugs at issued were merely “regulated, and not available to the public without a doctor’s prescription.” People v. Ross, 12 Misc.3d 755, 761 (Kings Co. Crim. Ct. 2006). And like the offense of Criminal Sale of a Prescription for a Controlled Substance by a Practitioner or Pharmacist (NY Penal Law § 220.65), the actual exchange of the drugs themselves need not be at issue. Written prescriptions authorizing their distribution, lawfully by a pharmacist, can be a sufficient factual basis for the charging and prosecution of this offense.

What are the Potential Penalties for Medicaid Fraud?

Just as there are many potential statues that a prosecutor can use to charge a defendant with Medicaid fraud, there are many potential penalties available under the law. One major determining factor in the seriousness of a charge is the value of the items in the alleged fraud. For example, New York Penal Law §178.10 says that the core offense of criminal diversion in the fourth degree is a class A misdemeanor.

However, if the value of the items involved rises to $1,000 or more, the charge becomes a felony. The most serious versions of these offenses can carry prison sentences of up to 15 years. A New York City attorney can assess the nature of a defendant’s alleged Medicaid fraud and determine what penalties they may be facing.

The Role of Intent in Medicaid Fraud Cases

Most allegations of fraud in New York City have one common element: every prosecution must be able to prove that a defendant intended to commit the fraudulent act. As a result, an effective defense to many of these allegations can be demonstrating that a defendant made a mere mistake and did not intend to cause any harm.

Our attorneys can examine the evidence in the case to determine if a prosecutor can prove that a defendant intended to cause harm. If not, we can present evidence at trial that demonstrates the lack of criminal mindset to create reasonable doubt in the minds of jurors.

Retain New York City Medicaid Fraud Attorneys Today

If you or someone you know has been arrested for Medicaid or Medicare fraud and unlawfully profiting from the sale of prescriptions, consider contacting one of our top defense attorneys to discuss potential defenses in your case. Exchanges of money for prescription drugs or written prescriptions for drugs can, and often do, cover perfectly legal conduct that occurs every day in the regular practice of medicine and strong defenses may be available in the right case.

Discuss the circumstances surrounding your arrest with our experienced New York City Medicaid fraud lawyers. Our skilled defense team may be able to put together powerful argument favoring a dismissal of the charges against you long before trial. With our experienced advocates on your side, your arrest and prosecution for a Criminal Diversion of Prescriptions offense may be resolved without loss to freedom, livelihood, and ultimately, good name within the state.

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