NYC Healthcare Fraud Defense Attorney

Get an Experienced Former Prosecutor on Your Side

Federal and state healthcare laws are hard to understand, and going through the legal system alone can feel like an uphill battle. You’re in the right place if you’re a medical professional or healthcare provider concerned about your career, reputation, and freedom.

At the Law Offices of Mehdi Essmidi, we understand healthcare fraud cases and the high stakes involved. As a former NYC prosecutor, healthcare fraud attorney Mehdi Essmidi knows how these cases are made. Call us for a free consultation.

Healthcare Fraud

A federal health insurance program is a government-run system that provides health insurance coverage to eligible individuals. The primary federal health insurance programs are Medicare and Medicaid.

Healthcare fraud involves submitting false claims to Medicare, Medicaid, or private insurance companies for financial gain. It’s a complicated area of the law that can include many activities, from billing for services not rendered to upcoding charges.

In New York, healthcare fraud is prosecuted under state and federal laws:

New York Penal Law § 177.00

New York State Penal Law § 177.00 makes it illegal for individuals or entities to provide false information or omit material facts in claims for health insurance payments. The severity of the offense is determined by the amount of money obtained by fraud over a one-year period. Penalties can vary from a class A misdemeanor to a class B felony for amounts exceeding $1 million.

False Claims Act (31 U.S.C. §§ 3729-3733)

The Federal False Claims Act (FCA) is a federal law that introduces liability on individuals and companies who submit false claims to the government or cause such claims to be submitted, including Medicare and Medicaid.

18 U.S. Code § 1347

18 U.S. Code § 1347 is a federal statute that criminalizes healthcare fraud and any attempt to execute a scheme to defraud a healthcare benefit program or to obtain money or property from a healthcare benefit program by false or fraudulent pretenses. It applies to public programs like Medicare and Medicaid, as well as private insurance plans.

Physician Self-Referral Law (Stark Law)

The Physician Self-Referral Law is a federal statute prohibiting physicians from referring Medicare or Medicaid patients to entities providing designated health services (DHS) if the physician or a close family member has a financial relationship with that entity. If you are under a medicare fraud investigation, hiring a New York fraud attorney can make all the difference in the outcome of your case.

Types of Healthcare Fraud Cases We Handle

Our experienced healthcare fraud attorneys are dedicated to defending individuals accused of defrauding healthcare benefit programs, ensuring they receive legal representation against charges of Medicaid and Medicare fraud.

Medicare Fraud

Medicare fraud happens when people submit fraudulent claims to the federal Medicare program. This can refer to billing for services not provided, upcoding charges, or providing unnecessary treatments. The investigations involve state and federal agencies, and having a former prosecutor like attorney Mehdi Essmidi can increase your chances of a favorable outcome.

Medicaid Fraud

A Medicaid fraud investigation can include falsifying patient eligibility, billing for phantom services, or engaging in kickback schemes. Mehdi Essmidi, a Medicaid fraud lawyer, has a successful track record fighting federal prosecutors in New York City.  

Pharmacy Fraud

Pharmacy fraud can include billing for prescriptions never filled, switching prescribed drugs for cheaper alternatives, or participating in prescription drug diversion schemes. We have experience handling government program allegations and complicated cases.

Possible Defenses

The potential consequences of Medicaid and Medicare fraud include civil penalties, financial restitution, and even jail time. Some possible defenses we may use:

Lack of intent: Showing that any billing errors were unintentional mistakes rather than intentional fraud.

Challenging the evidence: Examining the prosecution’s evidence for inconsistencies or violations of your rights during the investigation.

Statute of limitations: The alleged fraudulent activity occurred outside the statute of limitations.

Every case is different, and the best defense depends on the facts of your case. At the Law Offices of Mehdi Essmidi, we carefully review your case and prepare a customized defense strategy to protect you and your future.

Examples of Healthcare Fraud

Healthcare fraud laws in New York categorize the offense into various degrees based on the amount defrauded and the severity of the crime. Here are some examples that can lead to healthcare fraud charges:

Phantom Billing: Billing for services not provided.  

Upcoding: Billing for a more expensive procedure or service than what was actually provided. 

Unbundling: Billing separately for procedures that are typically charged as a package. 

Kickbacks: Receiving payment for patient referrals. 

Unnecessary Services: Performing and billing for medical services that are not medically necessary. 

Falsifying Diagnoses: Changing a patient’s diagnosis to justify unnecessary tests, surgeries, or other procedures.

Drug Diversion: Healthcare providers getting prescription drugs for personal use or illegal distribution.

Double Billing: Billing more than once for the same service, either to the same payer or to multiple payers.

Misrepresenting Non-Covered Treatments: Billing for services not covered by Medicare or Medicaid as if they were covered procedures.

Conviction Consequences

A healthcare fraud conviction can include fines, imprisonment, loss of professional licenses, and exclusion from federal healthcare programs. That’s why you need an experienced NYC healthcare fraud lawyer. Here are some of the consequences you may face:

Criminal Penalties: Based on the severity of the fraud, you could face significant fines and imprisonment. Federal healthcare fraud convictions can carry up to 10 years in prison per count and up to 20 years if the fraud results in serious bodily injury.

Financial Penalties: Fines for healthcare fraud can be substantial. You could be required to pay up to $250,000 for individuals or $500,000 for organizations per count. You may also be ordered to pay restitution.

Loss of Professional License: A conviction could result in the suspension or complete revocation of your medical license.

Exclusion from Federal Healthcare Programs: You may be barred from participating in Medicare, Medicaid, and other federal healthcare programs, which can limit your ability to practice.

Asset Forfeiture: The government may seize assets obtained through fraudulent activities.

Other Fraud Cases We Defend

• Wire Fraud
• Immigration Fraud
• Insurance Fraud
• Tax Fraud
• Mail Fraud
• Credit Card Fraud

Contact Us Today for a Free Consultation

Whether you are dealing with Medicaid fraud, Stark Law violations, Medicare fraud allegations, or any other fraudulent scheme charges, don’t wait to get the legal help you need. Our law firm understands healthcare fraud cases and the high stakes involved in federal charges. Contact us for a free consultation today.

FAQs

What is healthcare fraud in New York?

Healthcare fraud is submitting false claims to government programs like Medicare, Medicaid or private insurance companies for financial gain. This can include billing services not provided, upcoding charges, or performing unnecessary medical procedures.

How does the Anti-Kickback Statute relate to healthcare fraud?

The Anti-Kickback Statute prohibits paying, offering, receiving, or soliciting anything of value to encourage or reward referrals for services reimbursable by federal healthcare programs.

What’s the difference between Medicare and Medicaid fraud?

Medicare fraud is a way of defrauding the federal Medicare program; Medicaid fraud refers to defrauding the Medicaid program. Both can have serious consequences that require legal assistance.

How can a healthcare fraud attorney help me?

An experienced attorney can create a defense strategy, negotiate with prosecutors, challenge evidence, and minimize potential penalties or get charges dismissed.