Health Care Fraud In The Third Degree: NY Penal Law § 177.15

by ECL Writer
Health Care Fraud In The Fifth Degree

Healthcare fraud is a type of white-collar crime where individuals submit fraudulent medical claims to health insurance companies or health plans with the intention of obtaining undeserved payments. Typically, healthcare fraud involves healthcare professionals like doctors, dentists, chiropractors, or pharmacists falsely billing insurance providers for services, products, or medications that were never actually provided to patients.

This offense is categorized into five degrees of severity, ranging from first-degree to fifth-degree healthcare fraud, with the specific degree determined by the amount of money obtained through the fraudulent activities.

Under New York Penal Law § 177.15, an individual would be charged with healthcare fraud in the third degree if they knowingly submit false healthcare claims and, as a result, receive payments to which they are not entitled. To qualify as third-degree healthcare fraud, the total payments received from a single plan must exceed $10,000 but not exceed $50,000.

Health Care Fraud In The Third Degree Sentence

Healthcare fraud in the third degree is classified as a class D felony. If you are found guilty of this crime, you may face a maximum prison sentence of 7 years. Alternatively, you could be sentenced to probation for a period of up to 5 years. In addition to these penalties, a conviction may also entail financial repercussions, including the obligation to repay the ill-gotten gains acquired through fraudulent activities, as well as the possibility of being levied a substantial fine.


To secure a conviction for healthcare fraud in the third degree, the prosecution must present evidence demonstrating that you received payments for false claims from a single health plan within a single year, with the total sum exceeding $10,000 but not surpassing $50,000. It’s important to note that if, for instance, you submitted claims that were invalid, but the insurance company never disbursed any payments to you, a conviction for healthcare fraud cannot be pursued.

Furthermore, if you did not knowingly submit false claims, then you cannot be found guilty of healthcare fraud in the third degree. For instance, if a technical glitch caused the computer to unintentionally submit the same claims multiple times without your awareness, this would not constitute fraudulent activity.

New York Penal Law § 177.15: Health Care Fraud In The Third Degree

An individual is deemed to have committed healthcare fraud in the third degree when they engage in the offense of healthcare fraud in the fifth degree on one or multiple occasions, and the total wrongfully received payment, or a portion thereof, from a single health plan within a span of no more than one year, surpasses three thousand dollars in total.

Related Offenses

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

Hiring a New York lawyer for a Health Care Fraud in the Third Degree case is imperative for a robust defense. This serious charge involves alleged fraudulent schemes within the healthcare system. A skilled attorney in New York’s legal landscape understands the intricacies of state laws and can navigate the complex healthcare regulations. They’ll work tirelessly to investigate the evidence, challenge the prosecution’s case, and protect your rights. With their expertise, you can build a solid defense, potentially reducing charges or securing an acquittal. Choosing the right attorney is crucial to ensure the best possible outcome in your health care fraud case.

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