Facing Federal Healthcare, Medicaid, and Insurance Fraud Charges?

Seeking Immediate Counsel from a Federal Defense Lawyer is Imperative

The earlier you receive expert counsel, the more likely your matter will end favorably. If you’re facing prosecution, contact us immediately.

Federal Healthcare and Medicaid Fraud Charges in New York

Codified by 18 U.S.C. § 1347, healthcare fraud has become one of the most prevalent federal offenses. Especially in the ongoing and everchanging COVID-19 world, healthcare fraud charges have encompassed a variety of criminal activity, spanning from double billing to doctors requiring unnecessary treatments and prescribing medications in an effort to bill insurance companies for services rendered.

The statute itself makes it a federal crime to defraud a healthcare benefit program or to fraudulently obtain any money. The key factor in any type of federal healthcare fraud case is the “intent to defraud.”

In addition to the common fraudulent activities alluded to above, federal prosecutors will typical bring healthcare fraud charges if evidence supports any of the following:

• Falsification of patient records, including prescriptions
• Solicitation or acceptance of referral fees, known as a “kickback”
• Submitting false information to CMS or other relevant federal agency
• Billing individual services rather than a bundle that is required by guidelines
• Incorrect billing, such as submitting billing for a higher rate than allowed
• Prescribing medications that are not necessary, or other types of prescription fraud

A conviction pursuant to 18 U.S.C. § 1347 can lead to hefty fines and decades in prison, especially if certain applicable enhancements are at play such as serious bodily injury or death to another individual in relation to the fraud.

Federal Insurance Fraud Charges in New York

On the state level, New York prosecutors have the authority, pursuant to New York Penal Law § 176 to charge individuals with insurance fraud if they suspect that you caused materially false information to be entered into an application or claim for commercial insurance. Additionally, insurance fraud is also committed when a person enters materially false information into a health insurance or personal insurance application or claim.

Notably, insurance fraud is completed upon its attempt or the execution of the documents, rather than when or if the theft takes place. Hence, the fraudulent applications or claims do not need to actually be paid, and the amount that the prosecution believes the defendant sought to fraudulently extract from the insurance company is what is used to determine the severity of the charges.

Sentencing & Penalties in New York

A healthcare fraud charge pursuant to 18 U.S.C. § 1347 carries significant penalties, typically with a maximum of 10 years’ imprisonment and a hefty fine. As with many other federal crimes, certain enhancements are likely to be applied by the government where applicable. A common aggravating factor includes serious bodily injury or death, which can greatly increase one’s sentencing exposure. 

Moreover, section 1349 provides that a conspiracy to commit healthcare fraud may be punished in the same fashion as the healthcare fraud itself.

It should also be noted that knowledge that the fraudulent conduct is illegal, much less knowledge of the specific provision of federal law which prohibits health care fraud, is not required for a conviction under these sections. 

If the defendant knows that the statements or representations they made to obtain money or services through a federal healthcare benefit program are fraudulent, that is enough to convict regardless of whether the defendant understood that their conduct was illegal.

How We Fight Federal Healthcare, Medicaid, or Insurance Fraud Charges in New York

Being charged with medical, healthcare, or insurance fraud is serious and complex. In today’s world, with an expansive insurance and healthcare industry based on novel coronavirus diseases and the everchanging COVID-19 landscape, it is easy for innocent medical professionals and doctors to be charged with federal fraud charges despite clear criminality. It is crucial that you meet these elevated charges with a diligent, sound defense.

Specifically, when facing these charges, it may be advantageous for your defense team to hire healthcare experts to counter the government’s claims of impropriety. Many times, these charges will turn on whether or not a medical service or services was properly billed to an insurance company and paid out in an appropriate, legitimate fashion. It is imperative that your defense team hire industry experts to push back and convince government regulators that legitimate business practices were followed in this realm.

Your Defense Begins Now

If you are accused of Medicaid, healthcare, or insurance fraud, hire a former prosecutor and preeminent criminal defense attorney who has dealt with these offenses on both sides of the courtroom. The steps your defense attorney takes, by way of investigation and creative advocacy, will increase your chances of successfully walking away from these accusations and shape the rest of your life.

The sooner you put your case in the hands of an experienced criminal defense lawyer who has years of experience in dealing with such cases, the more opportunity you will have to work toward a favorable outcome. We at The Law Offices of Jason Goldman can help you.