New York Health Care Fraud Attorney Statutes
Healthcare fraud costs federal and state governments billions of dollars per year while endangering the welfare of countless patients.
As a result, efforts to prosecute offenders have been rapidly intensifying, with healthcare fraud now leading the way as one of the most prosecuted crimes in the United States.
If you or someone you love is under investigation for health care fraud, or you have been formally charged with a crime, our New York attorneys are here to help. We have the experience needed to help defend you against all federal and state criminal charges and investigations related to health care fraud.
Types of Healthcare FraudHealthcare professionals play a vital role in our society, in that they are responsible for aiding patients in their time of medical need. Through their power to diagnose conditions, prescribe medicine, recommend testing and perform medical procedures, the actions of providers can make the difference between life and death. While healthcare professionals are understandably motivated by financial rewards, any activity which compromises the integrity of the care they provide could potentially constitute healthcare fraud. In other words, whenever you place your financial interests above the best interests of your patients, you could be exposing yourself to liability.
Here are some examples:
- When you recommend a patient for testing, the assumption is that compliance with your recommendation serves their best interests. If you would not have recommended the testing but for a kickback relationship you have with the facility, or a desire to increase your insurance reimbursements, or any other personal benefit you will derive, you are defrauding the patient in that you are abusing their assumption of trust in you.
- Healthcare fraud also defrauds insurers, who provide reimbursements for the care they are led to believe is medically necessary. When the services you billed for were less extensive, costly, or necessary than you claimed, and especially when those services were not provided at all, you are coercing an insurer to provide coverage under false pretenses.
Healthcare Fraud Detection in New YorkHealthcare fraud is a national problem that is being heavily investigated by multiple sources. Whether your conduct is uncovered by the DEA, FBI, or another federal or state regulatory agency, you could be charged both civilly and criminally under both state and federal law. The creation of new task forces to combat healthcare fraud is becoming a regular occurrence. As just one of many examples,
- New York Attorney General Eric Schneiderman recently established the Medicaid Fraud Control Unit (MFCU) to investigate and prosecute healthcare crimes. The agency is not funded by taxpayers but rather by revenue recovered through successful fraud prosecutions.
- The federal government provides the unit with a 3:1 matching fund, making the coalition of prosecutors, auditors, and investigators an incentivized and well-funded source of fraud detection.
- While this initiative has certainly succeeded in curbing the devastating financial effects of healthcare fraud, its vigilant detection efforts have led to many wrongful accusations against innocent providers.
New York Healthcare Fraud By Statute:If you commit healthcare fraud in New York, your conduct could be punishable under both state and federal statutes.
- Federal charges you could face include False Claims Act or Social Security Act violations, conspiracy to commit healthcare fraud, conspiracy to defraud the United States, violations of the Anti-Kickback statute, amongst countless related charges including money laundering and identity theft.
- At the state level, healthcare fraud is punishable under article 177 of the New York Penal Law.
- A person is guilty of healthcare fraud under that statute any time he or she intentionally defrauds a health plan by either knowingly and willfully providing materially false information, or knowingly and willfully omitting material information, in order to receive a payment that he or she is not entitled to.
Five degrees of Healthcare Fraud Statute:
- Healthcare Fraud in the 5th Degree: any healthcare fraud with no specific time limit or dollar amount.
- Healthcare Fraud in the 4th Degree: healthcare fraud results in at least $2000.
- Healthcare Fraud in the 3rd Degree: healthcare fraud totaling at least $10,000 within a year-long period.
- Healthcare Fraud in the 2nd Degree: healthcare fraud of at least $50,000 within a year.
- Healthcare Fraud in the 1st Degree: healthcare fraud results in at least $1,000,000 within one year.
|Healthcare Fraud in the 5th Degree
|Class A Misdemeanor
|Minimum: Probation Maximum: 1 year
|Healthcare Fraud in the 4th Degree
|Minimum: Probation Maximum: 1 ⅓ – 4 years
|Healthcare Fraud in the 3rd Degree
|Minimum: Probation Maximum: 2 ⅓ – 7 years
|Healthcare Fraud in the 2nd Degree
|Minimum: Probation Maximum: 5-15 years
|Healthcare Fraud in the 1st Degree
|Minimum: 1-3 Maximum: 25 years
Healthcare Fraud Cases in New YorkNew York cases involving healthcare fraud often evoke federal charges, which can result in severe penalties upon conviction. Below are just a few examples:
Here are some Cases:
Brooklyn Pharmacy Owner Charged with Health Care Fraud and Conspiracy to Distribute NarcoticsIn 2016, Brooklyn pharmacy owner Kian Gohari was convicted on one count of conspiracy to distribute narcotics and one count of conspiracy to commit healthcare fraud after he was caught operating his pharmacy as an illegal pill mill. Gohari agreed to distribute oxycodone pills to a co-conspirator, who in turn agreed to supply high-end medications, including certain expensive pain gels, HIV medications, and psychiatric drugs. Gohari billed Medicaid for hundreds of thousands of dollars worth of medically unnecessary prescriptions. As a result, Gohari faced a maximum sentence of 30 years in prison.
Brooklyn Medical Clinic Charged with Conspiracy to Commit Health Care Fraud and Money LunderingIn 2017, Valentina Kovalienko, the owner of two Brooklyn medical clinics, was convicted on one count of conspiracy to commit healthcare fraud and one count of conspiracy to commit money laundering, after taking part in a $55 million dollar healthcare fraud scheme. Kovalienko’s co-conspirators coerced patients to attend her clinics by paying them cash kickbacks. Kovalienko then fraudulently bill Medicare and Medicaid for services unlawfully provided by staff lacking the qualifying licensure to provide those services. Kovalienko funded the cash kickback payments by writing checks to third party companies under the guise that those companies provided services to the clinics, when in fact the companies merely cashed the checks on Kovalienko’s behalf. The scheme involved 20 co-conspirators. As a result, Kovalienko was sentenced to seven years in prison, was ordered to pay $30 million dollars in restitution, and to forfeit an additional $30 million dollars in assets.
Long Island Chiropractor Indicted on Charges of Health Care FraudIn 2018, a Long Island chiropractor was indicted on charges of healthcare fraud following allegations that he billed Anthem Blue Cross Shield for over $2 million dollars of unprovided services. While the case is still ongoing, he could face up to 10 years in prison if convicted.
What To Do:If you are facing healthcare fraud charges in New York, you need the counsel of a qualified criminal attorney. Whether your charges are brought under state or federal law, our criminal defense lawyers have the knowledge and experience necessary to assist you.