Manhattan Healthcare Fraud Defense Lawyer

Defense for Medical Professionals Accused of Federal Healthcare and Medicare Fraud

Federal authorities have intensified their focus on healthcare fraud, placing physicians, business owners, and medical professionals across Manhattan and the surrounding boroughs under increasing scrutiny. In June 2025, the U.S. Department of Justice announced one of the largest healthcare fraud takedowns in history, charging more than 100 defendants nationwide with over $1.2 billion in alleged fraudulent schemes.

This historic enforcement surge includes aggressive prosecutions in New York City, where federal investigators are targeting everything from telemedicine billing and genetic testing kickbacks to home health fraud, DME scams, and fraudulent billing of Medicare and Medicaid.

If you are a healthcare provider in Manhattan and have received a subpoena, been contacted by federal agents, or are facing criminal charges for alleged healthcare fraud, you need immediate, experienced legal counsel. At Sosinsky Law, we defend healthcare professionals, practice groups, and executives against federal fraud investigations and indictments in Manhattan federal court and across the Southern District of New York.

Call (212) 285-2270 now for a confidential consultation. The right defense begins with the right attorney.

A Nationwide Crackdown on Healthcare Fraud

According to the DOJ’s 2025 National Health Care Fraud Takedown, federal agencies coordinated a sweeping investigation that resulted in criminal charges against physicians, nurse practitioners, clinic operators, and business owners in 32 federal districts. The Southern District of New York played a prominent role in this enforcement effort.

Key focus areas included:

  • Telemedicine fraud and unnecessary durable medical equipment (DME) billing
  • Genetic and cardiovascular testing schemes
  • Kickback arrangements involving marketers, labs, and pharmacies
  • Home health services billed for non-existent or unnecessary care
  • Fraudulent billing for mental health and substance use disorder treatments

The DOJ, HHS-OIG, FBI, and other federal task forces are using advanced data analytics, whistleblower complaints, and digital forensics to aggressively pursue suspected fraud. The government is no longer simply looking to recover funds—they are prosecuting healthcare providers criminally, often alongside civil penalties and professional sanctions.

Common Federal Healthcare Fraud Charges

Healthcare providers and business owners in Manhattan may face a wide range of federal charges under 18 U.S.C. §1346 and related statutes. These include:

1. Healthcare Fraud (18 U.S.C. §1346)

Knowingly executing or attempting to execute a scheme to defraud a healthcare benefit program, such as Medicare or Medicaid.

2. False Claims Act Violations (31 U.S.C. §3729)

Submitting or causing the submission of false or fraudulent claims for payment to the federal government.

3. Anti-Kickback Statute (42 U.S.C. §1320a-7b)

Offering, paying, soliciting, or receiving remuneration in exchange for referrals or services reimbursable by federal healthcare programs.

4. Wire Fraud and Mail Fraud (18 U.S.C. §1343 & §1341)

Using mail or electronic communications as part of a scheme to defraud a federal program.

5. Conspiracy Charges (18 U.S.C. §371)

Agreeing with one or more persons to commit healthcare fraud or related federal offenses.

Penalties for these crimes may include:

  • Up to 10 or 20 years in federal prison per count
  • Criminal fines exceeding $250,000
  • Asset forfeiture
  • Exclusion from Medicare/Medicaid
  • Revocation of professional licenses
Federal Grand Jury Subpoenas in Healthcare Fraud Cases

Manhattan Is a Key Enforcement Zone

Federal prosecutors in the Southern District of New York (SDNY) are among the most experienced and aggressive in the nation. Healthcare fraud cases brought in SDNY often involve:

  • High-volume billing data from Manhattan medical practices
  • Joint investigations by HHS-OIG, the FBI, and state Medicaid fraud control units
  • Coordinated press releases and media coverage
  • Parallel civil qui tam (whistleblower) lawsuits

Sosinsky Law has decades of experience litigating complex federal cases in SDNY. We understand the tactics prosecutors use and how to defend against them. Whether your case involves one alleged false claim or a multi-million-dollar enterprise, we build defense strategies that anticipate the government’s moves and protect your rights at every turn.

Who We Represent in Manhattan Healthcare Fraud Cases

We provide legal defense for:

  • Physicians and surgeons
  • Chiropractors and physical therapists
  • Mental health professionals
  • Practice managers and clinic owners
  • Medical device and pharmaceutical executives
  • Billing and coding consultants
  • Telehealth platform administrators

Each of these roles carries distinct legal exposures. At Sosinsky Law, we tailor each defense to your professional responsibilities and the structure of your business, while aggressively challenging the government’s narrative.

Key Issues in Healthcare Fraud Defense

Federal healthcare fraud cases are rarely straightforward. Prosecutors often rely on volume-based data analysis, circumstantial evidence, or statements from cooperating witnesses. Common legal defenses we employ include:

1. Lack of Criminal Intent

To convict under most fraud statutes, the government must prove you “knowingly and willfully” intended to defraud a healthcare program. Honest mistakes in coding, billing, or medical necessity determinations do not rise to criminal liability.

2. Medical Necessity and Clinical Judgment

Whether a treatment was “necessary” is often a matter of professional discretion. We work with experts to validate the medical appropriateness of your services.

3. Invalid or Overbroad Search Warrants

If federal agents seized your business records, devices, or patient files, we review whether the warrant was properly obtained and executed. Violations can lead to suppression of key evidence.

4. Lack of Control or Knowledge

In group practices or administrative structures, individual providers may not be aware of every billing submission. We often demonstrate that our clients lacked direct involvement in the conduct being charged.

5. Entrapment or Government Overreach

If undercover agents or informants induced illegal activity, or if the government relied on flawed data analytics, we may pursue defenses based on entrapment or procedural abuse.

Responding to a Grand Jury Subpoena or Target Letter

Many healthcare fraud investigations begin quietly. If you have received:

You are likely the subject of a broader criminal investigation. Do not attempt to comply or explain your side without experienced legal counsel.

We assist clients at all stages of the investigation, including:

  • Asserting privileges and protecting patient confidentiality
  • Negotiating the scope of subpoenas and document production
  • Preparing clients for testimony or proffer sessions
  • Pursuing early resolution or pre-indictment negotiation

Why Choose Sosinsky Law

Attorney Fred Sosinsky has built a reputation for strategic, aggressive federal criminal defense in New York’s most high-stakes courtrooms. With over 30 years of experience in the Southern and Eastern Districts of New York, Fred has defended:

We bring:

  • In-depth knowledge of federal healthcare fraud statutes
  • Relationships with experts in medical billing, compliance, and EHR systems
  • Experience negotiating with SDNY prosecutors and federal agents
  • Proven results in trial, dismissal, and pre-indictment resolutions

Call a Manhattan Healthcare Fraud Defense Lawyer Today

The 2025 DOJ takedown proves that federal authorities are escalating their pursuit of alleged fraud in the healthcare sector. If your name appears in an investigation, your livelihood, freedom, and reputation are at stake.

Don’t wait until you’re indicted to protect yourself.

Call Sosinsky Law today at (212) 285-2270 for a confidential consultation with an experienced Manhattan healthcare fraud defense lawyer. We represent clients across Manhattan, the Southern District of New York, and beyond. Let us help you fight back before it’s too late.

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Case Results
A successful contractor was arrested and charged with felony possession of a loaded firearm and Class C felony possession of marijuana based upon the seizure of these items in a search pursuant to warrant. As has been well advertised, in almost all gun cases in NYC, prosecutors will insist on state prison sentences even for those willing to plead guilty. After presentation of mitigating evidence however, Mr. Sosinsky was able to negotiate a sentence of nine months in jail for his client, meaning his client was out in six months.
A young man who had been a heralded star high school hoopster in Brooklyn was indicted as part of a large multidefendant fraudulent check cashing conspiracy. The client unfortunately had previously been involved in a similar prosecution and worse yet had been arrested during the pendency of the federal case for yet again committing a similar offense. Notwithstanding these hurdles, Mr. Sosinsky was able to convince the federal judge to spare his client a prison sentence and allow him to earn his freedom while on probation.
Mr. Sosinsky represented a prominent attorney accused of assaulting and endangering the welfare of his 13 year son. It turned out that the child was being used as a pawn by the client’s ex-wife and that the incident at the heart of the case involved proper disciplining of a difficult and, at times, violent child. Eventually, the charges against the lawyer were dismissed.
Mr. Sosinsky obtained a verdict of not-guilty of murder in the execution style shooting of a young man involved in gang activities in Harlem, New York City. By demonstrating important differences in the description of the shooter from witnesses called by the prosecution, Mr. Sosinsky was able to raise valid doubts about the correctness of the identifications made at trial.
A few years back, Mr. Sosinsky represented a Manhattan man who was arrested after stabbing his wife in the neck numerous times with a knife in their Upper West Side apartment. The client was indicted for attempted murder. However, after having the client examined by a forensic psychiatrist, it became evident that a compelling insanity defense was in order. Eventually, the prosecutors involved were unable to adequately prepare to counter this defense and the case was dismissed.

NYC Criminal Defense

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