Health Care Fraud in New York

It has been reported that health care fraud costs the United States government tens of billions of dollars each year – with some estimates placing the figure as high as $100 billion in any twelve-month period. Due to these staggering losses, federal prosecutors and judges treat allegations of health care fraud – with schemes of varying degrees of complexity – extremely seriously. Indeed, the Department of Justice has made combating health care fraud one of its top priorities, with dedicated investigatory and prosecutory units created in 1996 as part of the Health Insurance Portability and Accountability Act (HIPAA), which also introduced a new federal criminal statute specifically targeted at health care fraud: 18 U.S.C. § 1347.

Pursuant to § 1347, whoever knowingly executes a scheme to either: i) defraud any health care benefit program; or ii) obtain by false pretenses any money or property owned or controlled by any health care benefit program in connection with either the delivery or payment for such benefit, may be imprisoned by up to ten years and fined. Further, if serious bodily injury to any person occurred as a result of the fraudulent scheme at issue, the punishment is increased to a maximum of 20 years imprisonment, and if the death of any person occurred as a result of the fraud, the maximum sentence is increased to life imprisonment. Most commonly, these fraudulent schemes include billing for services never performed or medical supplies never provided, providing medically unnecessary services, or intentionally misrepresenting the details of medical services that were provided (e.g., the nature, date, or type of service or supplies provided) merely for the purposes of increasing the size of the medical bill.

In cases where health care fraud is alleged, the following additional charges are commonly brought by federal prosecutors: conspiracy to defraud the government with respect to claims (18 U.S.C. § 286); making false, fictitious or fraudulent claims (18 U.S.C. § 287); theft or embezzlement in connection with health care (18 U.S.C. § 669); making false statements relating to health care matters (18 U.S.C. § 1035); mail fraud (18 U.S.C. § 1341); and wire fraud (18 U.S.C. § 1343). Further, at their option, a civil and/or administrative case may be brought by the government, with the former possibly resulting in treble damages and the forfeiture of the defendant’s assets, and the latter possibly resulting in his or her inability to participate in federally funded health care initiatives in the future.

Hiring a top criminal health care fraud defense attorney to defend you in any federal prosecution is crucial and will ensure that every viable defense is explored and utilized on your behalf. Lawyers at the Law Offices of Jeffrey Lichtman have successfully handled countless federal cases and health care fraud cases, exploiting holes in the prosecution’s evidence to achieve the best possible result for our clients. Contact us today at (212) 581-1001 for a free consultation.