The H.E.A.T taskforce was created in 2010 by the Department of Health and Human Services in an attempt to fight back against the growing issue of healthcare fraud. New York healthcare fraud is often referred to as health insurance fraud or medical billing fraud, and it is one of the most significant fraud-related crimes in the state today. A person may be accused of healthcare fraud for a number of reasons, including:
- Billing patients for services or procedures that they did not want, or need
- Billing patients for services or medical procedures that they did not actually receive
- Billing patients for services that are more expensive than the ones that they received – a behavior known as up-coding.
- Billing patients in the form of duplicate claims – meaning that patients receive one of the procedures and services that they’re billed for, but are charged twice for the same service or procedure.
In most circumstances, the crime of healthcare fraud in New York is committed by medical professionals who attempt to claim more than they are entitled to from insurance providers.
Laws and Penalties
Healthcare fraud is a serious offense within the state of New York. Individuals who are convicted under the False Claims Act can receive penalties that include up to five years in prison, alongside a fine of up to $250,000. As in most crimes, the sentence that is given for healthcare fraud can depend on the amount of money that has been gained. The penalties in New York are addressed by Article 177 of the New York penal code, which defines punishments for a range of healthcare fraud offenses, including:
- Healthcare fraud in the first degree – Classed as a B felony crime. This offense refers to any individual with the intent to defraud a health plan by knowingly supplying false information or failing to provide relevant information. The value of the defrauded money in these instances must exceed $1,000,000 in 1 year. The penalty for this crime is up to twenty-five years in prison, with the possibility of millions of dollars in fines.
- Healthcare fraud in the second degree – This class C felony requires the same mental state as first-degree healthcare fraud, but a value of defrauded materials of only $50,000 within a year. For first time offenders, probation is usually the penalty, but defenders with a criminal history may receive up to fifteen years in prison.
- Healthcare fraud in the third degree – This class D felony involves the theft of funds equaling more than $10,000 within a year, and repeat offenders can get up to 7 years of incarceration.
- Healthcare fraud in the fourth degree – This class E felony involves healthcare fraud of funds exceeding $2,000, and can result in up to four years in jail for repeat offenders.
- Finally, healthcare fraud in the fifth degree is a Class A misdemeanor that does not involved a time limit or aggregate dollar amount. Usually, these crimes carry a sentence that does not exceed more than one year in prison.
Healthcare Fraud Defenses
Typically, healthcare fraud defenses revolve around a lack of intent and knowledge from the defendant when it comes to committing the offense. For instance, in most cases of healthcare fraud, a lawyer might argue that the accused:
- Did not have any knowledge of the fraudulent behavior that they were involved in, or lacked the knowledge required to understand that they were submitting a fraudulent claim. Because medical billing issues and health insurance are often quite complicated matters to deal with, it can be easy to make mistakes.
- Did not have any intention to actually defraud the insurance company. If the prosecutor cannot show that the accused purposefully defrauded the insurance company, then that person may be exonerated.
Statute of Limitations
As a federal crime, healthcare fraud in New York is considered under Section 18 USC 3282, which means that the statute of limitations currently stands at five years. In other words, a person cannot be prosecuted for healthcare fraud if a complaint isn’t filed within five years of the accused or alleged action. However, even if you do not get prosecuted for healthcare fraud, it is possible to lose a medical license if you are found guilty, and you may struggle to get a job in your field in the future depending on your records.
New York Healthcare Fraud Cases
- Prosecutors fight against bid for new trial for nursing assistant convicted of $9.5M healthcare fraud
- New York pharmacist pleads guilty to healthcare fraud and tax fraud
- Ring leader in $2M Medicare fraud sentenced to 15 months in jail
- Indian American doctor charged with healthcare fraud
- NY Jewish charity pleads guilty to Medicaid fraud