Health Care Fraud In The Fifth Degree: NY Penal Law § 177.05

by ECL Writer
Health Care Fraud In The Fifth Degree

Healthcare fraud constitutes a form of white-collar criminal activity characterized by the submission of inaccurate medical claims with the intent of obtaining reimbursement from health insurance providers or health plans. To illustrate, if a medical practitioner were to present a claim for a medical procedure they never actually conducted, with the aim of receiving payment for the fictitious procedure and subsequently received payment from the insurance company, this would constitute an instance of healthcare fraud.

There are five distinct degrees of offenses pertaining to healthcare fraud, with the fifth degree being the least severe and the only one classified as a misdemeanor. According to New York Penal Law § 177.05, an individual can be charged with healthcare fraud in the fifth degree when they knowingly submit a false healthcare claim and consequently receive payments they are not entitled to. The total amount of payments obtained in this fraudulent manner must not exceed $3,000.


Healthcare fraud in the fifth degree is classified as a Class A misdemeanor, carrying the potential for a maximum one-year jail sentence upon conviction. Additionally, individuals found guilty of this offense may be subject to a probation term of up to three years and may be obligated to pay a fine as part of their penalty.


In accordance with New York Penal Law § 177.30, individuals employed as bookkeepers, clerks, or in similar roles, who carried out their duties under the direct instructions of a manager without personally gaining any benefits, cannot be subject to prosecution for healthcare fraud.

New York Penal Law § 177.05: Health Care Fraud In The Fifth Degree

A fifth-degree healthcare fraud offense occurs when an individual, with the intent to deceive a health plan, knowingly and willfully supplies significantly inaccurate information or leaves out crucial information while seeking payment from a health plan for a healthcare item or service. If this misinformation or omission leads to an undeserved payment being received by the person committing the fraud or by another party, it constitutes a violation under the given circumstances.

Related Offenses

Hiring A New York lawyer For Health Care Fraud In The Fifth Degree Case

When facing health care fraud in the fifth-degree case in New York, hiring an experienced lawyer is paramount. This offense involves knowingly and willfully participating in fraudulent activities related to healthcare claims or benefits. To navigate the complex legal landscape, you need an attorney well-versed in New York’s healthcare laws and regulations.

Your lawyer will assess the evidence, protect your rights, and craft a strong defense strategy. They’ll work diligently to challenge the prosecution’s case, negotiate potential plea deals, or represent you in court if necessary. With their expertise, you can increase your chances of a favorable outcome, minimizing the potential consequences associated with health care fraud charges.

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