New York Health Care Fraud Attorney

Health care fraud prosecution is a top priority for government law enforcement agencies. In the last several years, an alarmingly growing number or healthcare providers who participate in government-funded programs such as Medicare and Medicaid have been investigated, prosecuted, and convicted.

New York criminal defense attorneys at Joseph Potashnik and Associates PC routinely represent healthcare providers on individual and corporate levels in government audits, investigations, and prosecutions related to Medicare, Medicaid, and no-fault insurance payments as well as private insurance fraud investigations.

Under federal and state law and/or contractual provisions, the records of health care providers who participate in government funded health care programs such as Medicare and Medicaid are subject to review by the government.

Corporations with government contracts may have particular contractual obligations to cooperate in a government investigation.

Who Investigates Healthcare Fraud

Government agencies involved in healthcare fraud investigations include the Department of Health and Human Services (HHS) through the Office of Inspector General (OIG) and the Centers for Medicare and Medicaid Services (CMS), Department of Defense through the Defense Criminal Investigative Service, the Department of Justice (DOJ) through the FBI and U.S. Attorney General’s Office.

In New York, the local law enforcement agencies that conduct healthcare fraud investigations are the state Office of Medicaid Inspector General, the local District Attorneys, and New York Attorney General through the Medicaid Fraud Control Unit (MFCU).

Our New York healthcare fraud defense attorneys have handled just about all types of healthcare fraud cases with all of these agencies.

If you are a healthcare provider working with the government-funded programs, you must realize the risk that one day you and your practice may be audited or investigated by the government. Considering the complexity and the extremely confusing nature of Medicare and Medicaid regulations, you may be in trouble even if you did not intend to violate the rules. This could be extremely disruptive to business operations and staff morale. In order to minimize the exposure and business disruption, you must think ahead and prepare a plan that will address this situation. Speaking with our experienced attorneys before agents appear at your door can resolve many issues before they arise. If you or your practice are under audit or investigation by the government, contact us immediately to discuss your matter.

What Triggers Provider Medicaid Fraud Investigations

If you are a Medicaid Services Provider, here are some of the reasons you can be investigated for Medicaid fraud:

  • Billing Medicaid for services that have never been provided;
  • Falsifying patients’ diagnosis to justify tests or other procedures that aren’t medically necessary;
  • Misrepresenting procedures performed to obtain payment for non-covered services;
  • Up-coding – billing for a more costly service than the one actually performed;
  • Unbundling – billing each stage of a procedure as if it were a separate procedure;
  • Filing claims for fake services and medical conditions;
  • Filing claims for fake and staged car accidents;
  • Coverage claims for non-existent illnesses;
  • Filing claims for medical care coverage for staged, fraudulent auto accident injuries;
  • Illegal kickbacks;
  • Illegal fee sharing
  • Billing for services provided by unlicensed personnel in violation of Medicaid rules.

Medicaid fraud attorneys with Joseph Potashnik and Associates are legal experts on Medicaid fraud in New York. We have successfully handled hundreds of Medicaid fraud cases at all procedural stages. If you are a Medicaid Provider and are under investigation by law enforcement, call us today at (212) 577-6677.


The Basics Of Healthcare Fraud Investigations

Your practice might have come under the law enforcement radar in many ways. Once it’s flagged, an investigation will begin and it can continue for months or even years. In many cases investigation targets don’t even know that they are being watched. The agents will review your billing records, subpoena your bank records, speak with your patients or employees. Often, undercover agents would come in to your office hoping that you would conduct some illegal transaction with them. On some occasions, agents may simply raid your office and seize your files and computers.

What Should You Do If You Under Investigation?

When you realize that you are subject to a government healthcare fraud investigation, talk to us before talking to the investigators!

If you are under investigation, the “do-it-yourself” approach is wrong. How the case in handled in the early stage often determines the outcome, including the likelihood of whether criminal charges are filed against you. That is why a consultation with an attorney is absolutely critical before you discuss anything with the investigators.

If you are a healthcare practitioner targeted by law enforcement, you should never do the following:

  • Discuss the case with anyone
  • Allow anyone to review or remove any documents or files from your office unless they have a warrant
  • Alter any documents
  • Instruct your staff to lie

These actions will compound your problems and make your defense more difficult.

Your chances of a favorable outcome increase dramatically if you begin you defense in a Medicaid fraud case or health care fraud case. The government has already invested considerable time and resources in gathering evidence and building the case against you. They are ahead of the game and the sooner your defense team gets involved the better your chances. You need an experienced and dedicated legal team of New York healthcare fraud lawyers to beat the fraud investigators at their own game.

New York Medicare Fraud Lawyer

Representing clients in health care fraud cases, including Medicare fraud and insurance fraud cases is an extremely serious task that should be left to the experienced attorneys, not just any criminal defense lawyer.

The U.S. health care system is a complex system of various interactions between payers, providers, and patients, in fact so complex that it is often difficult to tell an honest error from deliberate fraud.

When you or your business is a target of a criminal investigation, our New York City healthcare fraud attorneys will carefully review the details to determine the best line of defense and mitigate future damages.

Healthcare fraud and Medicare fraud prosecution have increased significantly during the last several years both in New York and on the federal level. Our New York City healthcare fraud attorneys have represented physicians, dentists, nurses, therapists, chiropractors, pharmacies, hospitals, billing services, transportation providers, home health agencies, medical equipment suppliers, laboratories, nursing homes, and patients in all types of criminal investigations and prosecutions related to health care fraud, health insurance fraud, Medicare fraud, and Medicaid Fraud.

Whether it is you or your business that is the target of an administrative or a criminal health care fraud or Medicare fraud investigation, do not entrust your career, livelihood, and even your freedom to just any criminal attorney not experienced in complex health care fraud representations. Our New York City criminal lawyers have extensive experience in dealing with

  • The Department of Health and Human Services (”HHS”)
  • Office of Inspector General (OIG)
  • The Health Care Financing Administration (”HCFA”)
  • The Department of Justice
  • The FBI

Not every criminal probe results in criminal arrests. If we get involved in a case at the early investigation stage, we may be able to prevent criminal charges from being brought in the first place. If charges are brought, we will labor to have them reduced or dismissed. If necessary, our experienced trial lawyers who have handled hundreds of criminal trials will provide the most competent representation at trial.

New York Federal Healthcare Fraud Lawyers

The prosecution of an individual or corporation for Medicaid and Medicare fraud in federal courts can result in severe penalties and consequences. Obviously, the most severe consequence of a conviction is imprisonment. Moreover, a conviction, whether after a trial or through a guilty plea, will lead to collateral consequences which may be by far more damaging that the conviction itself. A corporate provider m will be prohibited from doing future business with the government, leading to bankruptcy of the business. A medical professional will be suspended from participation in the Medicare and Medicaid programs.

Practices that mainly depend on Medicaid and Medicare patients have been completely wiped out following an accusation of healthcare fraud.

Medicare and Medicaid Exclusion

Under the U.S. Department of Health and Human Services regulations, a felony conviction for Medicare or Medicaid fraud or patient will result in the mandatory exclusion of the person convicted from further participation in Medicaid and Medicare for at least 5 years.

At Joseph Potashnik and Associates PC, we have a wealth of experience dealing with federal healthcare matters at all stages from the audit or an investigation to trial and appeal. We also have represented a number of healthcare providers in exclusion cases. Even when the client is charged in federal court with healthcare fraud it could be possible to minimize or perhaps even avoid debarment or set the stage for an early termination of suspension. Speak with us as soon as possible if you have been investigated or accused of healthcare fraud.

Penalties and Consequences of Medicare Fraud and Medicaid Fraud

A physician accused of a health care fraud crime may be terminated from participating in Medicare, Medicaid, or another federally sponsored program or denied hospital privileges before actually being found guilty in court!

Pleading guilty to a crime or being convicted after trial means an inevitable disciplinary action by a licensing agency and potentially losing the medical license.

We are amongst very few law firms in the New York Metropolitan Area that focuses on defending physicians and nurses in disciplinary and licensing matters for Medicare and Medicaid fraud.

Here are some of our representative cases in the area of Medicaid and Medicare Fraud

  • Routinely represent Medicaid providers investigated by the Medicaid Fraud Control Unit in New York. In a recent case, we represented several providers each accused of stealing over a million dollars from Medicaid. We settled the case administratively, and the clients were not charged.
  • Successfully represented a defendant in federal court in a multi-million Medicaid fraud conspiracy case, securing a non-prison sentence.
  • Represented home care agencies, transportation companies, and medical practices in fraud investigations by state and federal authorities.
  • Represent Medicaid providers in administrative actions taken by the Office of Medicaid Inspector General. In a recent case on appeal we convinced the OMIG to reverse its decision to exclude our client, a healthcare provider, from participating in New York Medicaid Program.
  • Represented a physician charged with participation in a massive Medicare fraud scheme in New Jersey. Convinced court to agree to a sentence of probation.
  • Represented several dentists accused of Medicare Fraud in New York City, securing civil settlements for each.
  • Represented a transportation company investigated for overbilling the Medicaid program, convincing the prosecutors to agree to a civil settlement
  • Represented a pharmacy investigated for insurance fraud, securing a civil settlement.
  • Represented a nursing home care agency in a Medicare fraud investigation.
  • Represented a nursing home under investigation for Medicare fraud by the NY Office of the Inspector General

If you are under investigation for Medicare Fraud or health insurance fraud, you need to talk to us! Call our downtown office to schedule a confidential review of your case. Use our efficiency and expertise to your benefit and call us today! Contact us today to talk to a New York Medicaid fraud criminal defense lawyer.


New York State Healthcare Fraud Charges

In addition to federal and NY state laws pertaining to Medicaid Fraud, New York law also has laws against other health insurance fraud.

Health Care Fraud in the Fifth Degree (NY Penal Law 177.05) sets forth that a person is guilty of this crime by knowingly and willfully providing materially false information or by omitting material information in order to receive payment from a health plan or health care item or service, with the intent to defraud a health plan (generally a publicly or privately funded heath insurance or managed care plan or contract), and by actually receiving payments that he is not entitle to. This crime is an A misdemeanor and 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) all add to the misdemeanor charge, providing 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 from a single health plan, in a period of not more than one year, exceeds a certain amount of money. In the Fourth Degree that amount is $3,000; 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 constitutes a felony, with maximum sentences ranging from four years to twenty five years in state prison.

However, if the defendant is a non-management bookkeeper, clerk or other employee who, without personal benefit, executed the orders of a supervisor who generally supervises the defendant’s work, the defendant may be able to assert an affirmative defense.

If you are accused of health care fraud in NYC, you should be aware that this a serious legal matter, and that the consequences may include decades in prison. Your first step should be to consult an experienced New York City criminal defense attorney with special expertise in health care issues.

Call our experienced NYC criminal defense attorneys at (212) 577-6677 to schedule an immediate consultation.