New York Federal Health Care Fraud Penalties

In the last 10 years, there has been a significant uptick in health care fraud cases in New York, but it started even before that in 1996, when HIPAA was introduced. However, many people do not realize that when they commit health care fraud, they are opening themselves up to harsh New York federal health care fraud penalties. If you have been charged with health care fraud, a capable health care fraud attorney can be instrumental to your case. Contact a skilled lawyer that can work tirelessly to fight for you.

Elements the Government Must Prove

What the government must prove depends on what statute they are charged with. Sticking with the main healthcare fraud statute which is 18 USC 1347, they would need to either prove one of two things: a scheme to defraud any healthcare benefit program, or a scheme to obtain by false pretenses any money or property as a result of participation in a health care program. They would need to show that someone acted with criminal intent to get a benefit, either financial or medical, when in fact they were not otherwise entitled to it.

How Prosecutors Treat Health Care Fraud Cases

Health care fraud cases are very intense cases. Some estimates put the loss figures at about $100 billion a year for health care fraud and with those staggering losses, these allegations are treated extremely seriously and they are prosecuted intensely. That also means that the resultant New York health care fraud penalties are equally severe.

The prosecution typically proves intent by inferring from the rest of the evidence at trial. The prosecution does not have to actually show that someone intended to defraud either an insurance company or any other health care provider; they can infer that intent just from the person's acts.

Ranges, Penalties, and Penalty Determination in Health Care Fraud Cases

New York federal health care fraud penalties involve long periods of incarceration because of the serious nature of federal crimes. That being said, in most of the statutes such as 18 USC 1347, 18 USC 286, 287, 669 and 1035, there are ten-year caps on sentences. Specifically, 1347 has a ten-year cap, 286 and 669 have a ten-year cap, 18 USC 1035 and 287, which would be making false or fictitious claims or making false statements in regard to health care matters, they only have a five-year maximum sentence.

However, if the defendant, as part of this health care fraud, is charged with wire fraud or mail fraud, then the maximum sentence can become 20 years. It does not necessarily mean that that individual will do 20 years in prison but the greater the theoretical maximum goes, the greater the potential sentence an individual could serve.

Sentencing in Health Care Fraud Cases

New York federal health care fraud penalties and sentences depend on a number of aggravating factors. The biggest factor is the amount of money at issue for the fraud. The scope with regards to the number of individuals impacted by the fraud is also important, and whether someone was injured as part of the fraud or not can be instrumental to the case. In cases where someone is injured, people can receive very high sentences. If a person has a ten-year maximum, they could do six or seven years depending on the extent of the injury.

Role of a New York Health Care Fraud Attorney

When it comes to health care fraud cases, defense lawyers are always playing catch up. That is why it is vital that individuals look for someone who has experience fighting these cases and winning them. A common mistake people make in these situations,  is not having an attorney early enough in order to deal with investigators and making statements before they are represented by counsel.

Typically, there has been a very long investigation conducted by investigators, sometimes a year, sometimes two years, sometimes five years, and by the time a defense attorney is typically hired, it is usually at the close of that investigation right before an individual is going to be arrested or right before the government seeks to have an individual arrested.

The most important thing for a defense attorney to do is to get up to speed as quickly as possible and to understand, exactly, the evidence against the person they are helping. Once they are armed with this information, the lawyer can begin to build a case. 

Contacting a Lawyer

A health care fraud conviction would be a felony conviction, and so in addition to losing the right to vote, you could have the stigma of a felony on your record for the rest of your life, and it could be more difficult to get employment in the future. If you have a professional license you may lose your license as a result of the conviction and not be able to work. Your lawyer can work tirelessly to build a solid case for you and in the event of a conviction, a determined fraud attorney can mitigate the New York federal health care fraud penalties that you face.