New York Health Care Fraud in the First Through Fifth Degrees & Your Criminal Defense: Article 177 of the NY Penal Law

The New York State Attorney General and local District Attorney’s Offices actively pursue fraud regardless of where it rears it’s head. The heath care industry is not immune to such investigations by law enforcement. While numerous different criminal charges may stem from the same transactions, the common theme for fraud involving health care are the misdemeanor and felony crimes of Health Care Fraud in the First (PL 177.25), Second (PL 177.20), Third (PL 177.15), Fourth (PL 177.10) and Fifth Degrees (PL 177.05). While you may have a statutorily recognized defense, the following are the legal definitions for these crimes and ones that you need to familiarize yourself with in the event you are charged with any degree of Health Care Fraud in New York:

PL 177.05 – Health Care Fraud in the Fifth Degree

A person is guilty of health care fraud in the fifth degree when, with intent to defraud a health plan, he or she knowingly and willfully provides materially false information or omits material information for the purpose of requesting payment from a health plan for a health care item or service and, as a result of such information or omission, he or she or another person receives payment in an amount that he, she or such other person is not entitled to under the circumstances.

Health Care Fraud in the Fifth Degree is a class A misdemeanor punishable by up to one year a county jail (Rikers Island).

PL 176.10 Health Care Fraud in the Fourth Degree

A person is guilty of health care fraud in the fourth degree when such person, on one or more occasions, commits the crime of Health Care Fraud in the Fifth Degree and the payment or portion of the payment wrongfully received, as the case may be, from a single health plan, in a period of not more than one year, exceeds three thousand dollars in the aggregate.

Health Care fraud in the Fourth Degree is a class E felony punishable by up to four years in state prison. Penal Law – 176.15 Health Care Fraud in the Third Degree

A person is guilty of Health Care Fraud in the Third Degree when such person, on one or more occasions, commits the crime of Health Care Fraud in the Fifth Degree and the payment or portion of the payment wrongfully received, as the case may be, from a single health plan, in a period of not more than one year, exceeds ten thousand dollars in the aggregate.

Health Care Fraud in the Third Degree is a class D felony punishable by up to seven years in state prison.

Penal Law -176.20 Health Care Fraud in the Second Degree

A person is guilty of Health Care Fraud in the Second Degree when such person, on one or more occasions, commits the crime of Health Care Fraud in the Fifth degree and the payment or portion of the payment wrongfully received, as the case may be, from a single health plan, in a period of not more than one year, exceeds fifty thousand dollars in the aggregate.

Health Care Fraud in the Second Degree is a class C Felony punishable by up to fifteen years in state prison. Penal Law 176.25 – Health Care Fraud in the First Degree

A person is guilty of Health Care Fraud in the First Degree when such person, on one or more occasions, commits the crime of health care fraud in the fifth degree and the payment or portion of the payment wrongfully received, as the case may be, from a single health plan, in a period of not more than one year, exceeds one million dollars in the aggregate.

Health Care Fraud in the First Degree is a class B felony punishable by up to twenty-five years in state prison

Clearly, the New York State Legislature believes that any type of fraud involving health care is a serious offense. That being said, they also provided within the statute an “affirmative defense.” Pursuant to Penal Law 176.30:

In any prosecution under this article, it shall be an affirmative defense that the defendant was a clerk, bookkeeper or other employee, other than an employee charged with the active management and control, in an executive capacity, of the affairs of the corporation, who, without personal benefit, merely executed the orders of his or her employer or of a superior employee generally authorized to direct his or her activities.

While this defense may not apply to your particular set of facts and circumstances, that does not mean a valid and legitimate defense does not exist. Therefore, contact experienced criminal defense attorneys, such as the former Manhattan prosecutors at Crotty Saland PC, to protect your rights, liberty and integrity.

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