New York Federal Health Care Fraud Lawyer
It has been reported that health care fraud costs the United States government billions of dollars each year – with some estimates placing the figure as high as $100 billion in any twelve-month period. Due to these staggering losses, federal prosecutors and judges treat allegations of health care fraud – with schemes of varying degrees of complexity – extremely seriously.
The Department of Justice has made combating health care fraud one of its top priorities, with dedicated investigatory and prosecutorial units created in 1996 as part of the Health Insurance Portability and Accountability Act (HIPAA), which also introduced a new federal criminal statute specifically targeted at health care fraud: 18 U.S.C. §1347. If you are facing these allegations, a New York health care fraud lawyer from out firm could help you build a case in your defense.
How Does Someone Receive Charges of Health Care Fraud?
18 U.S.C §1347 describes that whoever knowingly executes a scheme to either defraud any health care benefit program or to obtain by false pretenses any money or property owned or controlled by any health care benefit program may be imprisoned by up to ten years and fined. Additionally, if serious bodily injury to any person occurred as a result of the fraudulent scheme at issue, the punishment is increased to a maximum of 20 years imprisonment, and if the death of any person occurred as a result of the fraud, the maximum sentence is increased to life imprisonment.
Most commonly, these fraudulent schemes include billing for services never performed or medical supplies never provided, providing medically unnecessary services, or intentionally misrepresenting the details of medical services that were provided (e.g., the nature, date, or type of service or supplies provided) merely for the purposes of increasing the size of the medical bill. Depending on the federal health care fraud charges against an individual, one of our experienced New York attorneys could determine what this person’s legal options are.
New York State Distinctions in Federal Health Care Fraud
New York distinguishes health care fraud offenses by the value of wrongfully obtained payments within a one-year period. Under New York Penal Law Article § 177.05 defines health care fraud in the fifth degree as knowingly and willfully presenting materially false information or concealing material information to obtain payments from a health plan, constituting a Class A misdemeanor. The offense increases in severity with first-degree health care fraud classified as a Class B felony when the aggregate wrongful payments exceed one million dollars. Unlike many general fraud statutes, New York’s graduated framework emphasizes monetary thresholds while requiring proof that the defendant acted knowingly and with intent to defraud.
New York prosecutions frequently involve fraudulent Medicaid claims, billing for services not rendered, upcoding, unbundling procedures, falsified patient records, or misrepresenting medical necessity to secure reimbursement. In addition to criminal penalties, defendants may face restitution orders, forfeiture, probation, imprisonment, exclusion from Medicaid participation, and professional discipline imposed by state licensing authorities. Prosecutors must establish every statutory element beyond a reasonable doubt, including the existence of a health plan, a materially false representation or concealment, and the defendant’s knowing intent to obtain unauthorized payments. These distinctions reflect New York’s structured statutory approach to combating health care fraud while protecting public healthcare resources.
Additional Federal Fraud Charges in New York
In cases where health care fraud is alleged, the following additional charges are commonly brought by federal prosecutors: Conspiracy to defraud the government with respect to claims (18 U.S.C. §286); making false, fictitious or fraudulent claims (18 U.S.C. §287); theft or embezzlement in connection with health care (18 U.S.C. §669); making false statements relating to health care matters (18 U.S.C. §1035); mail fraud (18 U.S.C. §1341); and wire fraud (18 U.S.C. §1343). Further, at their option, a civil and/or administrative case may be brought by the government, with the former possibly resulting in treble damages and the forfeiture of the defendant’s assets, and the latter possibly resulting in his or her inability to participate in federally funded health care initiatives in the future.
Treble damages are a civil remedy pursuant to New York State Finance Law § 189(1) allowing the government to recover three times the actual financial loss suffered due to a fraudulent scheme. A dedicated federal health care fraud attorney can help you understand and navigate the layers of civil and criminal legal frameworks that may be applicable to your case.
Civil Remedies Can Lead to Consequences
Even if the prosecution decides to pursue civil routes instead of criminal ones, the consequences are still devastating. A simple indictment can trigger an administrative suspension from health care billing and could lead to the permanent revocation of a medical or professional license. Under the False Claims Act, 31 U.S.C. § 3729, the government can issue civil penalties per individual false claim. In a medical practice with hundreds of daily billings, these fines can easily exceed millions of dollars, forcing immediate bankruptcy. A skilled attorney with extensive experience handling health care fraud cases can help shield you from these financially devastating outcomes.
The government increasingly relies on advanced data-mining algorithms to flag inconsistencies in billing —such as high rates of upcoding, which is billing for more expensive services than were actually rendered, or frequent use of specific modifier codes. Once these algorithms flag a practice, federal agencies like the Department of Health and Human Services Office of Inspector General and the FBI step in. By the time an investigator makes contact, they have often spent months quietly compiling your billing histories, patient files, and internal communications.
Speak with a New York Federal Health Care Fraud Attorney
Practicing in a clinical or medical setting in New York means operating under an incredibly complex regulatory microscope. While healthcare providers dedicate their lives to patient care, the federal government is on the lookout for fraudulent billing or similar situations. When a billing error or a misunderstood compliance directive escalated into a federal investigation, your liberty, assets, and entire professional career become immediately at risk.
Hiring a New York federal health care fraud lawyer to defend you in any prosecution is crucial as the punishments can be severe. Our fraud attorneys at the Law Offices of Jeffrey Lichtman have successfully handled countless federal cases, and could help you with your charges. Contact us today for a free consultation.