Insurance fraud is a serious crime that has been on the rise in recent years. This is a type of white collar crime that involves submitting false claims to an insurance company in an effort to collect money by fraudulent means. There are five different levels to health care fraud. Which penal code you are charged with depends on the amount of money involved. The potential consequences of each sentence depends on which level of crime you are charged with. The more money that is involved, the more serious the crime and the greater the consequences. New York Penal Code 177.10 addresses health care fraud in the fourth degree and is considered a class E felony. It is important to understand the different terms used, the law itself, and any potential defenses if you are charged with a violation of code 177.10.
Penal Code 177.10: Health Care Fraud in the Fourth Degree Broken Down
New York Penal Code 177.10 states a person is guilty of fourth degree health care fraud when they knowingly and willfully provide false information or omit material information to a health care plan with the intention of receiving a payment that they are not otherwise entitled to. Over a period of one year the amount fraudulently received must be over $3,000 but less than $10,000. It can be one claim or a combination of claims over a 12 month period.
The term “person” can mean either an individual or an entity and anyone who acts as an accessory to the individual or entity filing a false claim.
The term “health care plan” means any publicly or privately funded health insurance that makes payment for claims filed by the person supplying the medical service. New York State’s medical assistance program, Medicaid is considered a health care plan under this law.
This code can be violated by doctors, dentists, chiropractors, physical therapists, ambulance companies, or any other health care provider who submits claims for insurance reimbursement.
Doctor A submits double claims to an insurance company to receive double payment for the same service. If he received more than $3,000 but less than $10,000 he could be convicted of a violation of penal code 177.10.
There has to be knowing and willful intent to commit fraud for this charge to hold up in a court of law. If, for example, the computer system or insurance claims clerk sent double billings in error, this would be a defense. As soon as the error was detected, the doctor would need to notify the insurance company and pay back the double payment.
In addition, if a claims clerk or bookkeeper was just following orders and didn’t realize that they were filing double or fraudulent claims and didn’t receive any personal benefit, they wouldn’t be held responsible because the “knowing” clause wouldn’t be there.
A violation of Penal Code 177.10 is considered a class E felony. Conviction could result in a prison sentence of up to 4 years, probation of up to 5 years, restitution, and a fine. Even more serious could be the damage to your professional reputation. Your medical business could suffer with a loss of patients and patient trust. The most important thing to do if you are ever facing a charge of health care fraud in the fourth degree is to contact a New York defense attorney experienced in cases such as these. A good attorney will look at the detail of your case and mount the best defense possible to get the charges either dropped or reduced.