Healthcare Crimes and Punishments

If you are under investigation or have been accused of healthcare fraud – or if you are working for a healthcare provider that is engaged in fraudulent conduct – then you should consult with an experienced healthcare fraud lawyer immediately to protect your rights.

​Prosecutors have a very long list of criminal statutes they can choose from when charging someone with a healthcare crime.  Each statute is different in terms of what the prosecutor must prove and what types of penalties or punishment can be imposed in the event of a guilty plea or conviction.
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In general, healthcare crimes fall into the following categories:

• Fraud involving Medicare, Medicaid, and other government healthcare programs
• Fraud involving private insurance companies or individuals
• Endangering the health and safety of patients
• Accepting or offering kickbacks or bribes
• Unauthorized practice of a profession

As you can see from the descriptions below, the penalties for violating a healthcare criminal statute are severe.  They can include restitution of amounts paid for false claims, penalties, and prison sentences.  In addition, criminal charges and convictions can result in exclusion from government healthcare programs and the suspension or revocation of your professional license.

If you are facing an investigation or criminal charges, you need an experienced healthcare defense lawyer on your side immediately to protect your rights.  Call us today to schedule a consultation.

Call (212) 601-2728

New York State Healthcare Crimes
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Health Care Fraud
​N.Y. Penal Law Sections 177.05, 177.10, 177.15, 177.20, 177.25

The crime of Health Care Fraud in New York involves knowingly and willfully providing materially false information or omitting material information for the purpose of requesting payment from a "health plan" for a health care item or service.  The definition of a "health plan" includes both private insurance and government programs such as Medicaid.  If convicted, the court may impose a sentence of up to 25 years in prison depending on how much money was involved.

Scheme to Defraud in the First Degree
​N.Y. Penal Law Section 190.65

​The crime of Scheme to Defraud in the First Degree in New York has three variations.  The prosecution must prove only one of the following three variations:  (a) defrauding ten or more persons; or (b) defrauding more than one person and obtaining money or property worth more than $1,000; or (c) defrauding one or more vulnerable elderly persons.  If convicted, the court may impose a sentence of up to 4 years in prison.​

​Scheme to Defraud in the Second Degree
​N.Y. Penal Law Section 190.60

The crime of Scheme to Defraud in the Second Degree in New York requires proof beyond a reasonable doubt that the defendant engaged in a systematic, ongoing course of conduct with an intent to defraud more than one person or to obtain money or property from more than one person by false or fraudulent pretenses, representations, or promises.  The prosecution must prove that the defendant actually obtained money or property from one or more of those persons.  The identity of at least one of the victims must be proved, but it is not necessary to identify all the victims.  If convicted, the court may impose a sentence of up to 1 year in jail.​

Scheme to Defraud the State by Unlawfully Selling Prescriptions
​N.Y. Penal Law Section 190.70

The crime of Scheme to Defraud the State by Unlawfully Selling Prescriptions in New York requires proof beyond a reasonable doubt that the defendant intended to defraud the state by engaging in a scheme to make, sell, deliver prescriptions for sale, or offer prescriptions for sale, and obtained goods or services from the state worth at least $1,000 by doing so.  A conviction under this statute is also possible if the defendant caused the state to reimburse someone else for the goods or services.  A "scheme" requires proof of a systematic, ongoing course of conduct.  If convicted, the court may impose a sentence of up to 1 year in jail.

Grand Larceny
​N.Y. Penal Law Sections 155.30, 155.35, 155.40, 155.42

The crime of Grand Larceny in New York requires proof beyond a reasonable doubt that the defendant stole money or property with a value of at least $1,000.  If convicted, the court may impose a sentence of up to 25 years in prison depending on how much money was involved.

Petit Larceny
​N.Y. Penal Law Section 155.25

The crime of Petit Larceny in New York requires proof beyond a reasonable doubt that the defendant stole money or property with a value of less than $1,000.  If convicted, the court may impose a sentence of up to one year in jail.

Offering a False Instrument for Filing
​N.Y. Penal Law Sections 175.30, 175.35

The crime of Offering a False Instrument for Filing in New York requires proof beyond a reasonable doubt that the defendant, knowing that a written instrument contains a false statement or false information, he or she offers or presents it to a public office or public servant with the knowledge or belief that it will be filed with, registered or recorded in, or otherwise become a part of the records of such public office or public servant.  If convicted, the court may impose a sentence of up to 4 years in prison.

Endangering the Welfare of an Incompetent or Physically Incapable Person
​N.Y. Penal Law Sections 260.24, 260.25

​The crime of Endangering the Welfare of an Incompetent or Physically Incapable Person in New York requires proof beyond a reasonable doubt that the defendant recklessly or knowingly engaged in conduct which was likely to be injurious to the physical, mental or moral welfare of a person who is unable to care for himself or herself because of physical disability, mental disease or defect.  If convicted, the court may impose a sentence of up to 4 years in prison.​

Falsifying Business Records
​N.Y. Penal Law Sections 175.05, 175.10

​​​The crime of Falsifying Business Records in New York requires proof beyond a reasonable doubt that the defendant, with the intent to defraud:  (a) makes or causes to be made a false entry in an enterprise's business records; or (b) erase, delete and destroy through other means, the true entry in an enterprise's business records; or (c) omits or fails to make a true entry into the business record of an enterprise when they knew that they had a duty by law or by the nature of their position to make the entry; or (d) cause an omission or prevent the making of a true entry in an enterprise's business records.  If convicted, the court may impose a sentence of up to 4 years in prison depending on the nature of the conduct.​

Commercial Bribing
​N.Y. Penal Law Sections 180.00, 180.03, 180.05, 180.08

​​​​The crime of Commercial Bribing in New York applies to both those who offer or pay bribes and those who solicit or receive bribes.  A conviction requires proof beyond a reasonable doubt that the defendant  either (a) conferred, or offered or agreed to confer, any benefit upon any employee, agent or fiduciary without the consent of the latter’s employer or principal, with intent to influence his conduct in relation to his employer’s or principal’s affairs; or (b) without the consent of his employer or principal, he solicited, accepted or agreed to accept any benefit from another person upon an agreement or understanding that such benefit will influence his conduct in relation to his employer’s or principal’s affairs.  If convicted, the court may impose a sentence of up to 4 years in prison depending on the amounts involved.

Unauthorized Practice of a Profession
​N.Y. Education Law Sections 6512, 6514

​​​​​The crime of Unauthorized Practice of a Profession in New York requires proof beyond a reasonable doubt that a defendant (a) held himself out as licensed to practice a profession when he was not licensed or when his license was suspended, revoked or annulled; or (b) aided and abetted an unlicensed person to practice a profession; or (c) fraudulently sold, filed, furbished, obtained or attempted to sell, file, furbish or obtain a diploma, license, record or permit purporting to authorize the practice of a profession.  If convicted, the court may impose a sentence of up to up to 4 years in prison depending on the nature of the conduct.

Unauthorized Use of a Professional Title
​N.Y. Education Law Sections 6513, 6514

​​​​​​The crime of Unauthorized Use of a Professional Title in New York requires proof beyond a reasonable doubt that a defendant used a professional title that he was not authorized to use.  If convicted, the court may impose a sentence of up to one year in jail.

Willful Violation of Health Laws
​N.Y. Public Health Law Section 12-b

​​​​​​​The crime of Willful Violation of Health Laws in New York requires proof beyond a reasonable doubt that a defendant wilfully violated or refused or omitted to comply with a lawful order or regulation prescribed by any local board of health or local health officer.  If convicted, the court may impose a sentence of up to one year in jail.

Federal Healthcare Crimes
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​Making or Causing to be Made False Statements or Representations
​42 U.S.C. 1320a-7b(a)

​​​​​​​​​The crime of ​Making or Causing to be Made False Statements or Representations requires proof beyond a reasonable doubt that a defendant ​knowingly and willfully made or caused to be made a false statement or representation of a material fact in an application for any benefit or payment under a federal health care program.

Healthcare Anti-Kickback Law
​42 U.S.C. 1320a-7b(b)

​The crime of ​violating the Healthcare Anti-Kickback Law requires proof beyond a reasonable doubt that a defendant ​knowingly and willfully solicited or received any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind:  (a) in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under a federal health care program; or (b) in return for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under a federal health care program.

Making False Statements with Respect to Conditions or Operations of Institutions
​42 U.S.C. 1320a-7b(c)

​​​​​​​​​​The crime of ​Making False Statements with Respect to Conditions or Operations of Institutions requires proof beyond a reasonable doubt that a defendant knowingly and willfully made or caused to be made, or induced or sought to induce the making of, any false statement or representation of a material fact with respect to the conditions or operation of any institution, facility, or entity in order that such institution, facility, or entity may qualify (either upon initial certification or upon recertification) as a hospital, critical access hospital, skilled nursing facility, nursing facility, intermediate care facility for the mentally retarded, home health agency, or other entity for which certification is required.

Presenting False, Fictitious or Fraudulent Claims
​18 U.S.C. 287

​​​​The crime of ​Presenting False, Fictitious or Fraudulent Claims requires proof beyond a reasonable doubt that a defendant intentionally submitted false, fictitious, or fraudulent claims to an agency or department of the United States Government.  The maximum sentence is five years in prison.

Conspiracy to Defraud the Government
​18 U.S.C. 286

​​​​​The crime of ​Conspiracy to Defraud the Government requires proof beyond a reasonable doubt that ​a defendant entered into an agreement, combination, or conspiracy to defraud the United States, or any department or agency thereof, by obtaining or aiding to obtain the payment or allowance of any false, fictitious or fraudulent claim.

Making False Statements to the Government
​18 U.S.C. 1001

​​​​​​The crime of ​Making False Statements to the Government requires proof beyond a reasonable doubt that ​a defendant knowingly and willfully, make a materially false, fictitious or fraudulent statement or representation, in any matter within the jurisdiction of the executive, legislative or judicial branch of the United States.  The false statement does not have to be made directly to an employee of the federal government as long as it is “within the jurisdiction” of the federal government.  While you must know that your statement is false at the time you make it in order to be guilty of this crime, you do not have to know that the matter you are lying about is “within the jurisdiction” of a government agency.  For example, if you lie on your time records at work, and those records are used to support claims for reimbursement from Medicare or Medicaid, you could be prosecuted under this statute even though you did not know that your time records were being submitted to the government.