Healthcare fraud constitutes a criminal act wherein false medical claims are submitted to a health plan with the intent of obtaining illicit payments. A health plan encompasses any health insurance or managed care arrangement that offers healthcare services. This definition extends to include Medicaid.
The typical scenario involves a healthcare provider, such as a doctor, presenting claims for services that were never actually rendered to patients, subsequently receiving payments from the insurance provider. Another example entails a pharmacist filing claims for medications either never dispensed or given to someone other than the individual specified in the claim.
There are five distinct offenses associated with healthcare fraud, categorized as healthcare fraud in degrees one through five. The specific charge one faces hinges on the monetary gain derived from the fraudulence within the context of a health plan. According to New York Penal Law § 177.20, an individual can be prosecuted for healthcare fraud in the second degree if they knowingly submit false healthcare claims, resulting in payments exceeding $50,000 but not surpassing $1,000,000 from a single health plan.
Healthcare fraud in the second degree is classified as a class C felony. A conviction for this offense carries the potential for a maximum prison sentence of 15 years. Alternatively, you could be sentenced to probation for a period of up to 5 years. Furthermore, a conviction may entail financial obligations, including mandatory restitution and a significant fine.
To secure a conviction for health care fraud in the second degree, the prosecutor must substantiate that you obtained payments stemming from fraudulent claims through a single health plan, totaling more than $50,000 but not exceeding $1,000,000.
If the prosecutor fails to present concrete evidence regarding the precise amount of these payments, you may have a valid defense against the charge. For instance, if the prosecutor alleges payment amounts within a vague range, like between $300,000 and $500,000, it might be insufficient to support a second-degree health care fraud charge.
Additionally, in accordance with New York Penal Law § 177.30, you cannot face prosecution for health care fraud in the second degree if you were functioning as a bookkeeper, clerk, or any other employee solely following instructions without personally benefiting from the fraudulent activities.
New York Penal Law § 177.20: Health Care Fraud In The Second Degree
Health care fraud in the second degree is established when an individual, over one or more instances, engages in the act of health care fraud in the fifth degree, and the total wrongful payment, or its portion, received from a single health plan within a period of one year surpasses fifty thousand dollars in total.
- Health care fraud in the fifth degree: New York Penal Law § 177.05
- Health care fraud in the fourth degree: New York Penal Law § 177.10
- Health care fraud in the third degree: New York Penal Law § 177.15
- Health care fraud in the first degree: New York Penal Law § 177.25
Hiring A New York Lawyer For Health Care Fraud In The Second Degree Case
Hiring a New York lawyer for a healthcare fraud in the second-degree case is essential for navigating the complexities of the legal system. Second-degree healthcare fraud involves serious allegations, potentially resulting in substantial fines and imprisonment. An experienced attorney in New York understands the state’s healthcare laws, regulations, and court procedures, ensuring a robust defense. They can analyze evidence, build a strong case, negotiate with prosecutors, and provide guidance throughout the legal process. Choosing the right lawyer is crucial to protect your rights, reputation, and future in a healthcare fraud case in New York. Seek competent legal counsel promptly.