Sapone and Petrillo, LLP

Understanding the different degrees of health care fraud

On Behalf of | Dec 23, 2022 | Firm News

Health care fraud is a serious criminal offense in New York. Doctors and medical professionals charged with health care fraud face major penalties, which vary depending on the degree of the fraud.

What is health care fraud?

Before examining the different degrees, it is important to understand what health care fraud is. Health care fraud typically involves a doctor submitting false claims to an insurance company about services they provided and then receiving payment for those services.

To constitute health care fraud, the claims must be submitted to a health plan. This is a health insurance or managed care plan, including Medicaid.

There are 5 degrees of health care fraud under New York law. The degree to which you are charged depends on the amount of money you are alleged to have received for your false claim.

Health care fraud in the fifth degree is a misdemeanor, while all other degrees of health care fraud are felonies, which means the penalties are much higher.

Defenses to a health care fraud charge

There are potential defenses to health care fraud. The prosecutor must provide proof that you received the exact amounts of payments they are alleging.

Even if the prosecutor produces proof that you received payments, they must prove the total amount. Without this, they cannot sustain the charge.

Lack of intent is also another defense to any type of fraud charge. The prosecution must prove that you intended to defraud the health care plan, rather than submitting a claim by mistake or accident.

Additionally, New York law states that you cannot be charged with health care fraud if you submitted the claims at the instructions of someone else and did not receive any personal benefit from the payments.

A health care fraud conviction can cost you significant financial penalties and even land you in prison. The damage to your career and reputation is sometimes irreversible. Therefore, putting on the strongest possible defense is essential.