Healthcare fraud constitutes a form of white-collar crime, wherein individuals or entities falsely present medical claims to obtain reimbursements from health insurance providers or health plans. Typically, this type of fraud involves healthcare professionals, particularly doctors, who submit claims for medical procedures that were either never performed or not fully completed. Nevertheless, healthcare fraud can extend beyond physicians to include dentists, chiropractors, pharmacists, ambulance service operators, and others involved in filing claims with health plans for financial gain.
There are five degrees of offenses associated with healthcare fraud, categorized based on the fraudulent monetary gains within a single year. In accordance with New York Penal Law § 177.10, an individual may be charged with healthcare fraud in the fourth degree if they knowingly submit false healthcare claims and subsequently receive payments to which they are not legitimately entitled. To meet the criteria for this charge, the fraudulent payments must originate from a single healthcare plan and aggregate between $3,000 and $10,000.
Healthcare fraud in the fourth degree is classified as a class E felony. A conviction for this offense may result in a potential prison sentence of up to 4 years. Additionally, you could be subject to a probation term lasting up to 5 years. Financially, the consequences of such a conviction may involve mandatory restitution payments and a significant fine.
If you were unaware that you were submitting fraudulent claims, you cannot face a conviction for healthcare fraud in the fourth degree. For instance, if a technical glitch caused your computer to inadvertently submit the same claims repeatedly, this would not constitute fraud.
According to New York Penal Law § 177.30, you cannot be prosecuted for healthcare fraud if you were employed as a bookkeeper, clerk, or held a similar role, and your actions were solely in the execution of your supervisor’s directives without any personal gain.
New York Penal Law § 177.10: Health Care Fraud In The Fourth Degree
An individual is deemed to have committed healthcare fraud in the fourth degree if, on one or more occasions within a one-year period, they engage in the actions constituting healthcare fraud in the fifth degree and the total wrongful payments received from a single health plan exceed $3,000 in aggregate.
- Health care fraud in the fifth degree: New York Penal Law § 177.05
- Health care fraud in the third degree: New York Penal Law § 177.15
- Health care fraud in the second degree: New York Penal Law § 177.20
- Health care fraud in the first degree: New York Penal Law § 177.25
Hiring A New York Lawyer For Health Care Fraud In The Fourth Degree Case
Hiring a New York lawyer for a Health Care Fraud in the fourth-degree case is crucial for a strong defense. This offense involves knowingly making false statements or representations to obtain healthcare benefits or payments, a serious legal matter in New York. An experienced attorney will navigate complex healthcare regulations, assess evidence, and build a robust defense strategy. They’ll strive to protect your rights, challenge the prosecution’s case, and work towards minimizing potential penalties, which can include fines and imprisonment. Choosing the right lawyer ensures you have an advocate who can guide you through the legal process and safeguard your interests effectively.