Health Care Fraud In The First Degree: NY Penal Law § 177.25

by ECL Writer
Health Care Fraud In The Fifth Degree

Health care fraud constitutes a white-collar criminal activity involving the submission of fraudulent medical claims to a health plan with the intention of obtaining unauthorized payments. A health plan, in this context, encompasses any health insurance or managed care arrangement that facilitates the provision of healthcare services or items, including Medicaid.

The perpetrator of such fraud may take on various roles, such as a physician, dentist, chiropractor, pharmacist, or even an ambulance service operator. Additionally, individuals in positions of authority within a healthcare provider, such as owners or managers responsible for billing, can also engage in this illicit activity. For instance, a billing manager collaborating with a physician might send false claims to a health plan and, upon receiving payments, they share the ill-gotten gains.

In accordance with New York Penal Law § 177.25, one can face charges of first-degree health care fraud when knowingly submitting false health care claims, whether single or multiple, resulting in the receipt of payments exceeding $1,000,000 from a single plan within a year.

Health Care Fraud In The First Degree Sentence

First-degree health care fraud is classified as a Class B felony, and a conviction for this offense could lead to a probation sentence lasting up to 25 years. Furthermore, the financial repercussions of such a conviction may include mandatory restitution and a significant fine.


To secure a conviction for first-degree health care fraud, the prosecution must demonstrate evidence that you received payments for fraudulent claims exceeding $1,000,000 from a single health plan within a single year. If the payments surpass the million-dollar mark but are dispersed among multiple health plans or span a period longer than a year, you may have a legitimate defense against a first-degree health care fraud charge.

New York Penal Law § 177.25: Health Care Fraud In The First Degree

An individual is deemed to have committed first-degree health care fraud when, on one or multiple occasions, they engage in the offense of health care fraud in the fifth degree, and the total payment, or a portion thereof, wrongfully received from a single health plan within a one-year period, surpasses one million dollars in total.

Related Offenses

Hiring A New York Lawyer For Health Care Fraud In The First Degree Case

Hiring a New York lawyer for a first-degree health care fraud case is crucial for navigating the complex legal landscape. These cases involve serious allegations and potentially severe penalties, including lengthy prison sentences and substantial fines. An experienced attorney can provide invaluable guidance, crafting a robust defense strategy. They will assess evidence, challenge the prosecution’s case, and protect your rights throughout the legal process. Moreover, a knowledgeable attorney can help explore possible defenses, such as demonstrating discrepancies in payments or plan durations, to secure the best possible outcome. When facing such high-stakes charges, securing skilled legal representation is essential for safeguarding your future.

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