Health care fraud involves submitting false claims in medical partitioning to a health plan to receive a payment. A health plan is defined as a managed care plan, any health insurance, or any contract under the health care service or item provided. This definition is also included in Medicaid. Healthcare fraud can be committed when a doctor submits false claims to an insurance company for service that patients did not receive. In the end, the patients receive that money from the insurance firm as compensation. Another example can be from a pharmacist submitting false claims in an insurance company for medication provided to someone other than the listed in the claim or services not provided to the person.
Healthcare fraud has more than five related offenses. They include the healthcare fraud in the second, first, third, and fourth degrees. The specific amount of money received from the insurance firm will determine the degree of a crime. You will be charged as a result of committing the crime. Under the New York Penal Code 177:20, you could face prosecution for the second-degree health care fraud if you submit false information to an insurance firm knowingly. As a result of that action, you receive a payment that you are not entitled to receive. The amount of money you receive must be more than $50,000. However, it must not exceed $1,000,000.
Dr. Mark Kelly is one of the most prominent orthopedic surgeons. When he wanted to find ways to increase his income, he started billing insurance companies after performing unnecessary surgeries on the patients. For botched surgeries, he started receiving numerous complaints against his service. Investigators began searching his practice to find more evidence of what he was doing. If the amount of money he charged the insurance officers was not exceeding $1,000,00 and not less than $50,000, he could face prosecution for the third-degree health care assault.
1. First-degree health care fraud: New York Penal Law 177:25
2. Third-degree health care fraud: New York Penal Law 177:15
3. Fourth-degree health care fraud: New York Penal Law 177:10
4. Fifth-degree health care fraud: New York Penal Law 177:05
For you to face conviction for second-degree health care fraud, the prosecutor must prove that you received fraudulent claims from a healthcare medical facility that does not total less than $50,000. In this case, the money must also not exceed $1,000,000. You might have a defense against these charges if the prosecutor fails to provide enough evidence against this case. For instance, he might provide evidence that suggests you received $2,000,000. That is a big difference that eliminates this crime.
Furthermore, the New York Penal Code 177:30 you cannot be prosecuted for this crime if your job was to keep these records or any other employee under orders without a personal effort.
Second-degree health care fraud is a class C felony. You could face a 15-year prison term if you are convicted of the second-degree health care offense. A five-year jail probation term is also applicable to this sentence. Moreover, you can also pay a substantial amount of fine or restitution under this charge.
The NYC Criminal Attorneys Law Firm
You must consider contacting an experienced lawyer if you are under investigation for the second-degree health care fraud charge. While this conviction will ruin your career, it will also lay great financial stress on your family. You can also face a prison term as a result of these charges. The staff at NYC Criminal Attorneys Law Firm has many years of professional experience in defending clients in New York Criminal Courts. For a free consultation session, please contact us to speak with an experienced attorney.