Queens Medicaid/Medicare Fraud Lawyer

Strategic Defense for Federal and State Healthcare Fraud Allegations in Queens

If you are a healthcare provider or business owner in Queens who has been contacted by investigators or charged with Medicaid or Medicare fraud, the consequences can be severe. In recent years, the federal government and the State of New York have stepped up enforcement efforts against alleged healthcare fraud involving public insurance programs. The result has been an increase in arrests, indictments, and prosecutions across the borough of Queens. If your name is under scrutiny, you need an experienced Queens Medicaid/Medicare fraud lawyer who understands how these cases are prosecuted and how to fight back.

At Sosinsky Law, we represent physicians, pharmacists, nurses, clinic operators, and medical businesses accused of healthcare fraud in the Eastern District of New York (EDNY) and by New York State authorities. Our firm has a long track record of defending complex, high-profile federal and state healthcare fraud cases in Queens and throughout New York City. Attorney Fred Sosinsky brings over three decades of trial experience and deep knowledge of the criminal and regulatory systems that govern healthcare enforcement.

Call (212) 285-2270 today for a confidential consultation. Early action is key to protecting your license, your freedom, and your future.

Medicaid and Medicare Fraud in Queens: A Government Priority

Both federal and state prosecutors are focused on identifying and prosecuting fraud in New York’s healthcare system. The Eastern District of New York, headquartered in Brooklyn but covering Queens, is home to some of the most aggressive federal prosecutions in the country.

At the state level, the New York State Attorney General’s Medicaid Fraud Control Unit (MFCU) is responsible for investigating and prosecuting fraud against the Medicaid program. MFCU investigates not only billing fraud by providers, but also abuse and neglect of patients in healthcare facilities. MFCU has broad subpoena power and works in coordination with federal agencies, including the U.S. Department of Health and Human Services (HHS), the FBI, and the U.S. Attorney’s Office.

These agencies use data analysis, informants, undercover operations, and whistleblower lawsuits to identify providers they believe may be abusing Medicaid or Medicare funds. Targets are often notified through grand jury subpoenas, target letters, or unannounced visits from agents. If you have received any form of contact from these authorities, your next call should be to an experienced Queens healthcare fraud defense attorney.

What Constitutes Medicaid or Medicare Fraud?

Medicaid and Medicare fraud occurs when someone intentionally submits false information to receive payments or benefits they are not entitled to. This can take many forms, including:

Fraud can be charged under a variety of state and federal statutes, including:

  • 18 U.S.C. §1346 – Federal healthcare fraud

  • 18 U.S.C. §1341 and §1343 – Mail and wire fraud

  • 42 U.S.C. §1320a-7b – Anti-Kickback Statute

  • N.Y. Penal Law §175.35 – Offering a false instrument for filing

  • N.Y. Social Services Law §145-b – False statements related to Medicaid

Convictions for these offenses can lead to serious prison time, substantial fines, professional license revocation, and exclusion from participating in government healthcare programs.

Healthcare Professionals at Risk in Queens

The healthcare industry in Queens is vast and diverse. With that size comes increased scrutiny. Sosinsky Law represents a wide range of clients in healthcare fraud matters, including:

  • Physicians and surgeons

  • Dentists and chiropractors

  • Nurse practitioners and physician assistants

  • Pharmacists and pharmacy owners

  • Billing services and consultants

  • Home health and personal care agency owners

  • Diagnostic and lab testing centers

No matter your role in the healthcare system, if your practice has interacted with Medicaid or Medicare billing, you could become the subject of an audit, investigation, or prosecution. It is critical to act quickly to protect your interests.

How Medicaid and Medicare Fraud Cases Begin

In many cases, healthcare providers learn they are under investigation when they receive one of the following:

  • A grand jury subpoena for documents or testimony

  • A target letter from the U.S. Attorney’s Office

  • A civil investigative demand or audit notice

  • A visit from MFCU investigators or federal agents

  • Notice of search warrant execution at a clinic, pharmacy, or office

Whether you are being investigated by the federal government or the Medicaid Fraud Control Unit, it is essential that you do not speak with investigators or produce records without legal counsel. Early legal intervention can often narrow the scope of investigations or even prevent formal charges from being filed.

Common Allegations in Queens Healthcare Fraud Cases

The allegations in Medicaid and Medicare fraud cases in Queens typically fall into the following categories:

1. Phantom Billing

This involves billing for services or procedures that were never actually rendered. In many cases, discrepancies between patient records and billing submissions lead to fraud accusations.

2. Kickbacks and Illegal Referrals

Both state and federal laws prohibit paying or receiving any form of compensation for patient referrals involving government insurance programs. Prosecutors often examine joint ventures, space rental agreements, or marketing contracts for potential violations.

3. Home Health Billing Violations

The government is aggressively targeting home care agencies in Queens for allegedly submitting false time records, billing for non-existent patient visits, or employing unqualified caregivers.

4. Medically Unnecessary Services

Federal and state prosecutors may claim that services were billed that lacked clinical justification. These allegations often rely on retrospective reviews by government experts.

5. Pharmacy and Prescription Fraud

Pharmacies are often accused of billing for prescriptions not filled, participating in prescription recycling schemes, or filling unnecessary prescriptions tied to telehealth scams.

Defense Strategies in Healthcare Fraud Cases

At Sosinsky Law, we focus on dismantling the government’s case before it can reach trial. Each case requires a tailored strategy, but common defenses include:

Lack of Intent

We demonstrate that any billing errors or overpayments were the result of clerical mistakes or misinterpretation of complex billing rules, not an intentional scheme to defraud.

No Involvement in Billing

In large practices or agencies, billing is often handled by third-party vendors or administrative staff. We work to establish that the accused individual had no direct role in the submission of claims.

Medical Necessity

We bring in independent experts to support the legitimacy of services rendered and counter claims that care was unnecessary or fabricated.

Statutory Exceptions and Safe Harbors

In Anti-Kickback investigations, we examine whether any safe harbor provisions apply to the structure of the business relationships in question.

Procedural Challenges

We aggressively challenge unlawful searches, improper subpoenas, or overbroad document requests. If the government violated your constitutional rights, we move to suppress evidence.

Penalties for Medicaid and Medicare Fraud

The consequences of a conviction or even a civil judgment in a healthcare fraud case can be life-altering:

  • Federal prison time up to 10 or 20 years depending on the statute

  • Fines and restitution that may exceed hundreds of thousands of dollars

  • Asset forfeiture including bank accounts and property

  • Exclusion from Medicaid and Medicare participation

  • Loss of professional license and NPI number

In addition, many providers face reputational harm, closure of their practice, and the inability to obtain future employment in the healthcare field.

Why Choose Sosinsky Law for Your Queens Healthcare Fraud Case

Fred Sosinsky is a trusted name in federal criminal defense with decades of experience representing clients in some of the most serious fraud cases in New York. He has litigated numerous cases involving complex healthcare billing systems, federal audits, and high-stakes indictments.

When you choose Sosinsky Law, you benefit from:

  • Over 30 years of federal trial experience

  • Strategic insights into how MFCU and federal prosecutors operate

  • Access to expert witnesses in billing, coding, and compliance

  • Personalized, aggressive defense at every stage of the process

Our mission is to protect your rights, preserve your livelihood, and fight back against government overreach.

Contact a Queens Medicaid and Medicare Fraud Lawyer Today

Whether you are a licensed medical professional, a clinic administrator, or a healthcare business owner in Queens, facing Medicaid or Medicare fraud allegations is a serious legal challenge. You do not have to face it alone.

Call Sosinsky Law today at (212) 285-2270 to speak directly with an experienced Queens Medicaid/Medicare fraud lawyer. We are ready to help you respond strategically to subpoenas, investigations, audits, or criminal charges in the Eastern District of New York and before New York State agencies.

SOS? CONTACT SOSINSKY

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

Contact Fred Sosinsky