Health Care / Medical Fraud

New York has very strict laws against any type of health care or medical fraud and there are five degrees to the offense of health care fraud that can be charged to a person found to be in violation of the law. Even in its lowest form, this offense is charged as a class A misdemeanor meaning that the court can order time be served behind bars for committing this offense. Call now for a free consultation with one of our experienced New York criminal attorneys to discuss your case and see what options are available to you.

For the purposes of the following discussion of the degrees of charges of health care fraud, use of the word person means an individual or entity other than the person who is supposed to be the recipient of a health care item or service under their health plan. Health plan refers to any private or public health insurance, managed care plan or contract where health care services or items are provided. Medicaid is defined as a single health plan for the purposes of this law.

As stated previously, health care fraud in the fifth degree is a class A misdemeanor, and the only degree of this offense that is not a felony charge. This charge applies when a person knowingly provides incorrect or false information for the purpose of requesting payment from a health care plan for an item or service and payment is received that they are not entitled to. For example, this could be a provider intentionally lying about having provided a service to a patient in order to receive higher compensation from the insurance company. If a person does this on one or more occasions within a year period and from a single health plan and payment received is more than $3000, the charge of health care fraud in the fourth degree applies which is a class E felony.

When a person has committed health care fraud in the fifth degree on one or more occasions within a year period and the payment wrongfully received is more than $10,000, the charge is now a class D felony and could mean up to seven years in prison if convicted. If, under the same conditions, but the amount received is in excess of $50,000, the charge applies as a class C felony and becomes a class B felony when the amount is over $1,000,000.

It is important to know that these charges apply to the person who is making the directive that the incorrect or false information be provided to the health plan. What this means is that an employee who is not in acting in management or executive capacity and is being directed to generate the false information provided to the health plan by their superior or employer have more options available to them to fight these charges. The charges are intended to apply to the acting person who is directing that the false information be submitted, but the court does not necessarily hold those who are acting under direct orders to the same degree of blame. Regardless of if you are a provider and facing these charges or an employee of such provider, call now for a free consultation with our experienced team of New York criminal attorneys to discuss what options are available to you.