Medicaid/Medicare Fraud

Experienced Medicaid Fraud Lawyer In New York City

Under 18 USC §1347, individuals who knowingly and willfully engage in schemes to defraud healthcare benefit programs or obtain money through false pretenses are guilty of healthcare fraud. Allegations of healthcare fraud are grave and can result in charges ranging from misdemeanors to severe felonies. To prove fraud, a prosecutor must establish both the act of deception and the defendant’s intent to deceive.

If you are facing allegations relating to healthcare fraud, our trusted Medicaid fraud lawyer in New York City is prepared to advocate on your behalf. At Sosinsky Law, we will assess the strength of the prosecutor’s case and develop a strategy to protect your rights, both inside and outside the courtroom. Contact our skilled federal criminal defense attorney now at (212) 285-2270 for a free consultation.

Types Of Medicaid Fraud Offenses In New York

To be convicted of healthcare fraud, the prosecution must be able to prove two elements:

  • The existence of a scheme aimed at defrauding or obtaining funds from a healthcare benefit program in relation to the provision or payment for healthcare benefit items or services; and
  • The defendant’s deliberate and knowing participation in the execution or attempted execution of said scheme.

Some of the common forms include:

  • Medical identity theft
  • Billing for unnecessary services or items
  • Billing for services or items not furnished
  • Up-coding
  • Unbundling and
  • Kickbacks

Sosinsky Law offers the expertise of federal healthcare fraud attorney Frederick Sosinsky. If you require top-notch legal representation, we are here to assist you. Our comprehensive knowledge in handling Medicaid fraud cases sets us apart. Reach out to us today to discover how we can help you with your Medicaid fraud case and provide you with further information.

What is the Criminal Diversion Act?

To mount a robust defense in a criminal case, whether at the state or federal level, it is crucial for top Medicaid Fraud lawyers in New York City to thoroughly understand the elements required for successful prosecution. When it comes to the offense of Criminal Diversion of Prescriptions, state prosecutors must establish, beyond a reasonable doubt, that the defendant knowingly engaged in the Criminal Diversion Act. This specific element is precisely defined in New York Penal Law § 178.00 (3), (a) – (d). These four subsections necessitate the prosecution’s ability to prove, during trial, that the defendant acted with full knowledge.

  • Transferred or delivered, in exchange for anything of pecuniary value, prescription medication or device with the knowledge or reasonable grounds to know that the recipient has no medical need for it; or
  • Received, in exchange for anything of pecuniary value, prescription medication or device with the knowledge or reasonable grounds to know that the seller or transferor is not authorized by law to sell or transfer such prescription medication or device; or
  • Transferred or delivered a prescription in exchange for of pecuniary value; or
  • Received a prescription in exchange for anything of pecuniary value.

According to the statute, a “prescription medication or device” refers to any item that requires a prescription for lawful sale, delivery, or distribution. It is evident that this provision encompasses more than just controlled substances under state law. In fact, one court held that it only requires prosecutors to establish that the drugs in question were regulated and not available to the public without a doctor’s prescription.

Similarly to the offense of Criminal Sale of a Prescription for a Controlled Substance by a Practitioner or Pharmacist, the actual exchange of the drugs themselves is not necessarily a factor. Written prescriptions authorizing the lawful distribution by a pharmacist can serve as a sufficient basis for charging and prosecuting this offense.

Legislations On Fraud And Abuse

Doctors and other medical professionals must adhere to numerous federal laws. For a comprehensive understanding of these laws, engaging the services of a Medicaid fraud attorney in New York City is highly recommended. Here are some of the key laws to be aware of:

  • Federal False Claims Act, (FCA)
  • Anti-Kickback Statute
  • Criminal Health Care Fraud Statute
  • Stark Law: The Physician Self-Referral Law
  • The Exclusive Statute
  • Civil Monetary Penalties Law

Penalties for Medicaid Fraud

Prosecutors have a range of potential statutes to charge defendants with Medicaid fraud, each carrying its own set of penalties. The severity of the charge often hinges on the value of the items involved in the alleged fraud. For instance, according to New York Penal Law §178.10, the core offense of criminal diversion in the fourth degree constitutes a class A misdemeanor.

However, if the value of the items exceeds $1,000, the charge escalates to a felony. In the most severe cases, these offenses can result in prison sentences of up to 15 years. Our NYC Medicaid fraud lawyer can carefully evaluate the nature of a defendant’s alleged Medicaid fraud and determine the potential penalties they may face.

The Role of Intent in Medicaid Fraud Cases

Most fraud allegations in New York City share a common requirement: prosecutors must establish the defendant’s intent to commit the fraudulent act. Consequently, a compelling defense strategy often involves demonstrating that the defendant’s actions were unintentional and resulted from a mere mistake, without any intent to cause harm.

Our skilled Medicaid fraud attorney in NYC meticulously analyzes the evidence in each case, assessing whether the prosecutor can sufficiently prove the defendant’s intent to cause harm. If not, we strategically present evidence during trial to establish the absence of a criminal mindset, thereby instilling reasonable doubt in the minds of the jurors.

Contact Our NYC Medicaid Fraud Lawyer Now

If you or someone you know has been arrested for Medicaid or Medicare fraud and unlawfully profiting from the sale of prescriptions, we recommend reaching out to our highly skilled NYC Medicaid fraud lawyer at Sosinsky Law. We can provide expert guidance on potential defenses in your case.

Our dedicated defense team can work diligently to build a powerful argument favoring a dismissal of the charges before the trial. Do not delay, contact Sosinsky Law now for a free consultation and to learn more about how we can help build your defense and secure the best possible outcome in your case.


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