Health Care Fraud Defense Lawyers in NYC
Last updated on May 19, 2026
The health care industry is one of the largest in the United States. The government takes claims of fraud in the health care industry very seriously. If you are facing health care fraud charges, a guilty verdict could result in extensive jail time and fines. With so much at stake, you should work with a New York City federal criminal defense attorney who has the skill and experience necessary to protect your rights.
At Sapone & Petrillo, LLP, our experienced trial attorneys will defend your rights in or out of the courtroom when you have been charged with fraud. From our New York City and Long Island offices, we have created cutting-edge legal solutions for clients throughout the United States. We will work with you to build a strong defense that protects your future.
Health Care Fraud Comes In Many Forms
Health care fraud is a type of fraud charge that can include a wide variety of fraudulent activities in a health care setting. Health care fraud can include:
- Fraud in clinical trial results
- Pricing fraud for pharmaceuticals
- Billing for defective test kits
- Knowing the sale of defective medical devices
- Violation of anti-kickback laws in a health care setting
- Medicare and Medicaid fraud
- Providing unlicensed medical services
- Phantom and overbilling – private health insurance, Medicaid and Medicare
This form of fraud is also one of the most common charges brought under the False Claims Act. Because of this, whistleblowers are encouraged to come forward when they believe fraud has occurred, and they receive incentives to do so. This can make fighting back against these charges particularly difficult, but working with a skilled lawyer can be key to creating the most favorable results for you.
Legal Defenses In New York Health Care Fraud Cases
When facing charges of health care fraud in New York, it is essential to explore all potential defenses to protect your rights. Some of the common legal defenses that may be used in health care fraud cases include:
Lack Of Intent
One of the key elements in a health care fraud charge is proving that there was intentional wrongdoing. Many allegations stem from billing errors, misunderstandings of complex regulations or clerical mistakes. If there was no intent to defraud, these actions are not criminal. In such cases, the prosecution may struggle to prove the necessary intent to commit fraud, leading to a potential dismissal of charges. A defense built on a lack of intent can significantly weaken the case against you.
Insufficient Evidence
The prosecution must prove every element of health care fraud beyond a reasonable doubt. If the evidence is weak or based on circumstantial factors, the case against you may not be strong enough to lead to a conviction. A well-prepared defense can highlight weaknesses in the prosecution’s case, potentially resulting in the dismissal of charges. If the prosecution cannot establish concrete proof of fraud, this could provide an opportunity for the charges to be reduced or dropped altogether.
Good Faith And Compliance Efforts
Demonstrating a good-faith effort to comply with laws and regulations is a strong defense in health care fraud cases. If you can show that you made a reasonable effort to adhere to health care laws or had a robust compliance program in place, this can help mitigate the severity of the charges and penalties you face. Courts often consider the intent behind actions and whether there was any effort to comply with applicable regulations. Showing evidence of your commitment to compliance can influence the court’s decision and reduce your legal exposure.
Statute Of Limitations And Procedural Defenses
Health care fraud charges must be brought within a specific time frame, which is governed by the statute of limitations. If the prosecution fails to file charges within this deadline, the case may be dismissed. Additionally, if evidence used against you was obtained unlawfully, procedural defenses can be raised to exclude that evidence from the case. If the evidence against you is inadmissible due to improper handling or violation of rights, it could result in a favorable outcome for your case.
Expert Testimony
In many health care fraud cases, expert testimony can be crucial to explaining complex billing practices and regulatory requirements to the court. Expert witnesses, such as medical professionals or industry compliance experts, can provide valuable insights into whether the alleged fraudulent behavior was in fact a misunderstanding or an innocent mistake, rather than intentional fraud. Their testimony can help clarify the context of actions that may have been misinterpreted and provide a clearer view of the legal and procedural standards at play.
Contact A New Yor City Federal Criminal Lawyer
If you have been accused of health care fraud, speaking to an experienced federal criminal defense attorney could be key to protecting your freedom and your future. Call our firm at 646-844-3445 or contact us online to arrange an initial consultation with our lawyers.