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With growing problems surrounding health care fraud, New York’s Attorney General Eric Schneiderman formed a special unit to investigate and prosecute such crimes. The Medicaid Fraud Control Unit (“MFCU”) of the Attorney General’s Office is comprised of prosecutors, investigators, and auditors who are devoted to cracking down on Medicaid fraud. 

While this has helped them greatly in reducing the prevalence of health care fraud, the level of dedication has also resulted in more cases of people in the health care industry being wrongfully investigated and charged. If you are a member of the health care industry and are facing criminal charges or an investigation, an experienced attorney can help you navigate New York health care fraud charges and penalties.

New York Health Care Fraud Charges and Penalties

Article 177 of the Penal Law lists crimes associated with health care fraud. “Health plan” is defined by New York law to include any public or private health care plan. This can be Medicare, Medicaid, TRICARE, as well as plans offered by private insurers.

The following outlines the degrees of New York health care fraud charges and penalties, starting with the most serious offense.

Health Care Fraud in the First Degree

• Health Care Fraud in the First Degree (Penal Law § 177.25) is defined as when the individual intends to defraud a health plan, and then knowingly and willfully gives false or incomplete information in order to receive reimbursement or payment from a health care plan to which they are not entitled.
• First-degree charges require the total amount stolen to exceed $1 million and occur in a one-year period.
• It is considered a B non-violent felony.
• Penalties may include a minimum of 1 to 3 years of incarceration, with a maximum sentence of 8 1/3 to 25 years.

Health Care Fraud in the Second Degree

• Health Care Fraud in the Second Degree (Penal Law § 177.20) involves the same mental state as first-degree charges, but the total amount stolen must be up to $50,000 in a one-year period.
• It is considered a C non-violent felony.
• Penalties may include probation for first-time offenders, although it is punishable by up to a maximum of 5 to 15 years in state prison.

Health Care Fraud in the Third Degree

• Health Care Fraud in the Third Degree (Penal Law § 177.15) requires the total health care funds stolen to exceed $10,000 in a one-year period.
• It is considered a D non-violent felony.
• Penalties may include probation for first-time offenders, while the maximum sentence is up to 2 1/3 to 7 years’ incarceration.

Health Care Fraud in the Fourth Degree

• Health Care Fraud in the Fourth degree (Penal Law § 177.10) is considered an E non-violent felony.
• Fourth-degree charges require total health care funds stolen to exceed $3,000 in a one-year period.
• Penalties generally include probation for first-time offenders, while the maximum sentence is 1 1/3 to 4 years in prison.

Health Care Fraud in the Fifth Degree

• Health Care Fraud in the Fifth Degree (Penal Law § 177.05) is considered a Class A misdemeanor.
• It is like the types of fraud previously mentioned, but fifth-degree charges do not require a total stolen dollar amount or a time period constraint.
• Penalties for most misdemeanor crimes do not exceed 1 year in jail, and often times first-time offenders are not sentenced to incarceration.

Defense Against Health Care Fraud Charges

Health care fraud is not an offense characterized by accident or negligence. Rather, a person who has committed health care fraud must be found to have acted intentionally to receive health care payments, reimbursements, and other benefits. For this reason, defending a New York health care fraud case usually focuses on the question of intent. Anyone with experience in the medical field can attest to the regulations around billing and insurance having a unique complexity, resulting in mistakes as a fairly common occurrence. While prosecutors attempt to frame errors as serious criminal offenses, an experienced defense attorney will work to protect the medical careers that people have made to help others.

Learn more about Pappalardo & Pappalardo, LLP can help you combat NY health care fraud charges.