NY Criminal Defense: NY Health Care Fraud

As one of the original founding member of the Manhattan District Attorney’s Office Identity Theft Unit after the unit’s creation and as a criminal defense attorney, I have had the opportunity to prosecute, investigate and defend individuals accused of a laundry list of crimes in the fraud arena. These NY crimes have included, but are not limited to, Forgery in relation to counterfeit currency, Identity Theft in relation professional GRE, GMAT and TOEFL test-takers and Money Laundering in relation to narcotics, prostitution, and escort services. One of the crimes that is becoming more prevalent is Health Care Fraud. According to New York Penal Law Article 177, there are five degrees of Health Care Fraud as follows:

Health Care Fraud in the Fifth Degree – NY Penal Law 177.05 – establishes that a person is guilty of this crime when, with the intent to defraud a health plan (generally a publicly or privately funded heath insurance or managed care plan or contract), he knowingly and willfully provides materially false information or omits material information for the purpose of requesting payment from a health plan or health care item or service and, as a result of such information or omission, he or another person receives payment in an amount that he or such other person is not entitled to under the circumstances. This crime is an A misdemeanor punishable by up to one year in jail.

Health Care Fraud in the Fourth, Third, Second and First Degree – NY Penal Law, 177.10, 177.15, 177.20, and 177.25 respectively – deviates from the misdemeanor charge in that a person is guilty of these charges if he commits the crime of Health Care Fraud in the Fifth Degree and the payment or portion of the payment that is wrongfully received, as the case may be, from a single health plan, in a period not more than one year, exceeds a certain amount of money. In the Fourth Degree that amount is $3000, in the Third Degree that amount is $10,000, in the Second Degree that amount is $50,000 and in the First Degree that amount is $1,000,000. Each of these crimes are felonies with maximum sentences ranging from four years to twenty five years in state prison.

Fortunately, for those accused of these crimes there is an affirmative defense set forth in the Penal Law. If the defendant is a non-management bookkeeper, clerk or other employee who, without personal benefit, executed the orders of a supervisor who generally authorizes the defendant’s activities, the defendant may be able to beat the charges. Therefore, the accused should contact an experienced criminal attorney who can present this defense to the District Attorney’s Office with to put and end to the investigation or prosecution.

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