I’ve Been Accused of Health Care Fraud in New York – What Do I Do?

Health care fraud is not a victimless crime. It affects everyone – both individuals and businesses alike – and causes tens of billions of dollars in losses each year. It can raise health insurance premiums, expose patients to unnecessary medical procedures and increase taxes. Medical providers, patients and others can commit health care fraud by deceiving the health care system to receive unlawful benefits or payments. Unfortunately, former patients and/or law enforcement have accused you and/or your New York practice of committing health care fraud. For more information on this subject, please read on, then contact one of our experienced HMO / Medicare / Medicaid audit protection lawyers today. Here are some questions you may have:

What constitutes health care fraud by medical providers?

Health care fraud charges involve intentionally trying to deceive or misrepresent medical claims to the government or receiving self-referrals.  These types of charges usually involve a doctor, clinic or other health care provider charging for goods or services that were either not actually provided to a patient or were not medically necessary.  Health care law is complex, so medical providers must navigate numerous laws to avoid both criminal and civil charges. Nonetheless, some examples of health care fraud charges include:

  • Falsifying certificates of medical necessity in order to bill services
  • Upcoding and unbundling
  • Falsifying plans of treatment or medical records to justify payments
  • Misrepresenting diagnoses or procedures to maximize payments
  • Soliciting “kickbacks” for the provision of various services or goods
  • Falsifying claims
  • Unlawfully prescribing and dispensing

What are the penalties for health care fraud in New York?

As a defendant, you could be charged under any combination of applicable laws, each of which comes with severe consequences that include prison time, steep fines and a loss of your medical license. If you face health care fraud charges, you should reach out to one of our skilled New York health care professional defense lawyers as soon as possible.

What are the possible defenses for health care fraud?

You and your lawyer have several possible defenses at your disposal. Depending on the circumstances, you might argue:

  • Lack of intent or mistake: You acted in good faith but made a mistake, accidentally omitted information, made an error or billed improperly.
  • Insufficient evidence: The government does not have sufficient evidence of your intent to defraud.
  • Compliance program: You and your lawyer developed a thorough compliance plan to detect and/or deter fraudulent activity in your practice or business before you faced charges, illustrating you lacked intent to defraud.
  • Consent: The alleged victim granted permission for your actions, thus you did not commit fraud.

If you have any further questions, give us a call today.

Contact our experienced New York City firm

If you are a medical professional accused of misconduct, contact the Walker Medical Law firm to set up a free initial consultation.