Manhattan Medicaid/Medicare Fraud Lawyer
Defense for Federal and State Healthcare Fraud Investigations in Manhattan
Healthcare fraud prosecutions are on the rise across New York, and Manhattan has become one of the most closely watched areas for Medicaid and Medicare billing activity. The federal government, along with New York State authorities, has dedicated vast resources to investigating and prosecuting alleged fraud against government healthcare programs. For doctors, pharmacists, home health agencies, and other healthcare professionals in Manhattan, even a routine audit or subpoena can quickly escalate into a full-blown criminal case. If you are under investigation or already facing charges, you need an experienced Manhattan Medicaid/Medicare fraud lawyer on your side.
At Sosinsky Law, we have decades of experience defending high-profile federal and state fraud cases, including those involving Medicaid and Medicare. Led by attorney Fred Sosinsky, our firm has handled some of the most complex healthcare-related criminal cases in the Southern District of New York (SDNY). We understand how these cases are built, how prosecutors think, and how to dismantle the allegations before they lead to devastating consequences.
Call (212) 285-2270 now to speak directly with a defense attorney.
Medicaid Fraud Control Unit (MFCU) and Federal Prosecution in Manhattan
In New York State, the Medicaid Fraud Control Unit (MFCU) operates under the Office of the Attorney General. MFCU is charged with investigating and prosecuting fraud involving the Medicaid program, including:
Fraudulent billing by healthcare providers
Neglect or abuse of patients in care facilities
MFCU works hand-in-hand with federal agencies such as the Department of Health and Human Services (HHS), the FBI, and the U.S. Attorney’s Office for the Southern District of New York. Cases often begin with data analytics or whistleblower complaints and may involve lengthy investigations before a provider even learns they are a target.
If MFCU agents or federal authorities contact your office, do not assume the matter is minor. Even a civil investigation can escalate into criminal charges. A prompt and strategic legal response can make the difference between a closed file and a federal indictment.
What Constitutes Medicaid or Medicare Fraud?
Healthcare fraud refers to any intentional deception or misrepresentation made to obtain unauthorized benefits from a healthcare program. In the context of Medicaid or Medicare, this includes:
Billing for services not provided
Charging for medically unnecessary services
Misrepresenting procedures or diagnoses
Double billing or unbundling services
Paying or receiving illegal referral fees or kickbacks
Common statutes used to prosecute these cases include:
18 U.S.C. §1346 (Healthcare fraud)
18 U.S.C. §1341 and §1343 (Mail and wire fraud)
42 U.S.C. §1320a-7b (Anti-Kickback Statute)
False Claims Act (31 U.S.C. §3729)
N.Y. Penal Law §175.35 (Offering a false instrument)
N.Y. Social Services Law §145-b (Medicaid false claims)
A conviction can lead to years in prison, loss of a medical license, financial penalties, and exclusion from federal healthcare programs.
Providers Most Commonly Targeted in Manhattan
In Manhattan, the high concentration of medical providers, clinics, pharmacies, and billing operations creates an environment ripe for enforcement. Prosecutors often target:
Physicians and surgeons with high Medicaid or Medicare billing volume
Specialists in pain management or physical therapy
Diagnostic labs and imaging centers
Pharmacists and pharmacy owners
Home health and personal care agencies
Behavioral health providers and addiction treatment centers
These providers may not even realize they are under scrutiny until a federal agent visits their office or a subpoena arrives demanding records. Do not wait to retain legal counsel until you are formally charged.
How Healthcare Fraud Cases Begin
Many of our clients first learn of an investigation through:
A grand jury subpoena requesting patient records, billing files, or testimony
A target letter from the U.S. Attorney’s Office
A civil investigative demand from MFCU
A visit or inquiry from state or federal law enforcement
Notice of a search warrant execution at their home or business
These events should be treated as extremely serious. Anything you say or provide to investigators may be used against you in a criminal case. Contact Sosinsky Law immediately to assess the situation and begin protecting your rights.
Allegations We Commonly Defend Against
Healthcare fraud charges in Manhattan often involve one or more of the following claims:
1. Phantom Billing
Allegations that the provider submitted claims for services never rendered. This may stem from incorrect documentation, clerical mistakes, or fabricated claims submitted by a third party.
2. Upcoding and Unbundling
Prosecutors may allege that billing codes were inflated or split into separate services to increase reimbursement. In many cases, this is the result of confusion over code modifiers or improper training.
3. Medically Unnecessary Services
Federal agents may claim that services billed to Medicare or Medicaid were not clinically necessary. We counter this using medical records and expert witnesses to validate the provider’s decision-making.
4. Kickback Schemes
Even seemingly legitimate business relationships can be labeled illegal if prosecutors believe compensation was tied to patient referrals. We review lease agreements, marketing arrangements, and vendor contracts to show compliance with safe harbor laws.
5. Home Health Fraud
Home health agencies in Manhattan are frequently targeted for allegedly inflating hours, billing for unqualified aides, or submitting claims for patients who were not truly homebound.
Defense Strategies in Healthcare Fraud Cases
Each case is unique, and our approach is tailored to the facts and goals of the individual client. Some of the defenses we pursue include:
No Intent to Defraud
Federal and state prosecutors must prove that you acted knowingly and willfully. Honest mistakes, complex billing systems, or reliance on billing staff can support a lack of criminal intent.
No Personal Involvement
If the provider did not personally review or submit the claims, they may have a viable defense based on lack of knowledge and control. We help establish that billing was handled externally or by staff.
Medical Necessity
Even when there is disagreement over treatment, prosecutors must show that no reasonable physician would have provided the services. We work with expert witnesses to defend the clinical decisions at issue.
Safe Harbor Protections
The Anti-Kickback Statute includes multiple regulatory safe harbors. We evaluate whether the business arrangement in question fits one of these categories.
Procedural Violations
We carefully examine how the investigation was conducted, whether warrants were valid, and whether subpoenas were overly broad. When constitutional rights are violated, we seek to have evidence suppressed.
Penalties for Medicaid and Medicare Fraud
Healthcare fraud convictions are punished harshly in both federal and state courts. A conviction may result in:
Federal prison sentences of up to 10 or 20 years
Fines exceeding hundreds of thousands of dollars
Restitution and forfeiture of bank accounts, properties, and assets
Revocation of medical licenses and NPI numbers
Permanent exclusion from Medicaid and Medicare programs
Even if a case is resolved short of trial, a guilty plea may trigger mandatory exclusion and loss of livelihood. That is why a strong defense from the beginning is essential.
Speak to a Manhattan Medicaid and Medicare Fraud Lawyer Today
If you are facing a healthcare fraud investigation or indictment in Manhattan, do not wait to seek legal representation. A swift and strategic defense may protect your professional license and keep you out of prison.
Call Sosinsky Law today at (212) 285-2270 to speak with an experienced Manhattan Medicaid/Medicare fraud lawyer. We defend providers and businesses in the Southern District of New York and across the entire state. Your future is too important to trust to anyone but a proven defense firm.