What Are the Penalties for Medicare Fraud in New York?

Find Out (For Free) Why New Yorkers Hire Defense Attorney Dr. Nick Oberheiden 888-680-1745

It’s a tough time to be a doctor in New York. Few days go by without stories on new healthcare fraud allegations, indictments, arrests, search warrants, and other government pressure targeting NY healthcare business owners and providers. Your choice should be easy. You can either risk becoming another defendant, or you can choose lawyers who have successfully defended New York medical specialists and entrepreneurs in grand jury and federal fraud investigations, and healthcare audits. We have successfully represented:

• Mobile Ambulance Transportation Cases
• Mobile Radiology Services
• Home Healthcare Agency (Form 485 Cases)
• Hospice Care Representation
• Illegal Kickbacks
• Any Form of Medicare Fraudulent Billing
• Mental Healthcare Providers
• Cardiologists
• Urologists
• Oncologists
• Dialysis Centers
• Dentists
• Family Medicine Doctors
• Internal Medicine Specialists
• Pain Management Doctors
• Psychologists
• Psychiatrists
• Medicare Clinic Owners
• Nurses

Speak with New York Federal Criminal Defense Attorney Dr. Nick Oberheiden Anytime: 888-680-1745

almost exclusively focuses its practice on protecting and defending healthcare providers. We don’t mix other types of defense into our practice because we believe mastering healthcare laws and providing effective defense strategies is too important. In hundreds of healthcare cases, we have defended physicians and businesses against every fraud allegation.

Unlike any law firm you will find, Oberheiden P.C. almost exclusively focuses its practice on protecting and defending healthcare providers. We don’t mix other types of defense into our practice because we believe mastering healthcare laws and providing effective defense strategies is too important. In hundreds of healthcare cases, we have defended New York physicians and businesses against every fraud allegation.

• Call Us, the Law Firm Owner Will Personally Answer Your Call
• Team Includes Former DOJ Officials and U.S. Senate Confirmed Attorneys
• Personalized Service, No Junior Lawyers

What Are the Penalties for Civil Medicare Fraud in New York?

In civil Medicare fraud cases, the government doesn’t base its case on (criminal) intent. In such cases, federal authorities have statutory authority to sanction non-criminal Medicare fraud with civil penalties.

If your New York business receives a subpoena from the Department of Health and Human Services – Office of Inspector General (HHS-OIG), you are likely accused of submitting:

• False and fraudulent claims,
• Physician self-referrals,
• Kickbacks,
• Drug price reporting, and
• Other violations committed without criminal intent.

Many civil Medicare fraud cases are reported by former employees under the federal False Claims Act.

Under the Civil Monetary Penalty Law (CMPL) violations have increased from a previous $10,000 to now $20,000 per false claim.

Nick Oberheiden has avoided liability for clients in New York and elsewhere in dozens of civil fraud cases. Call him directly today at 888-680-1745 to hear how he would protect your business and assets.

What Does the Government Have to Prove in NY Medicare Fraud Cases?

Medicare Fraud can also be a federal criminal offense. Pursuant to 18 U.S.C. 1347, a person is guilty of healthcare fraud in New York federal court if the government prosecutors can prove beyond a reasonable doubt that the following mandatory elements exist:

• The defendant knowingly and willfully executed or attempted to execute a scheme to defraud a healthcare benefit program or obtain money or property from a healthcare benefit program by means of false or fraudulent pretenses, representations, or promises;
• The defendant executed or attempted to execute the scheme or plan in connection with the delivery or payment of benefits, items or services under the healthcare benefit program; and
• The defendant acted with the intent to defraud the healthcare benefit program.

As federal offenses, such violations are typically investigated by New York-based federal law enforcement agencies such as the Federal Bureau of Investigation (FBI), the Office of Inspector General (OIG), the New York Medicaid Fraud Control Unit (MFCU). They are prosecuted by Assistant United States Attorneys from the U.S. Attorney’s Office. New York is divided into four federal court districts.

• Northern District of New York
• Eastern District of New York
• Western District of New York
• Southern District of New York

What Are the Penalties for Criminal Medicare Fraud in New York?

If you have any questions, concerns, need to better understand the penalty calculation for Medicare Fraud in New York, or need to get guidance for an upcoming sentencing hearing—call Oberheiden P.C. today. We offer free and confidential initial consultations and we are available on weekends. Avoid the fallout of a federal investigation and possible prosecution, call 888-680-1745.

• A New York pharmacist was indicted for her role in a scheme to defraud Medicare. The indictment states the pharmacist owned two pharmacies and submitted claims to Medicare for payment for drugs that were either medically unnecessary or not dispensed. The drugs involved in the scheme were for the treatment of individuals with HIV. As a result of the scheme, Medicare paid out almost $8 million for the fraudulent claims. The pharmacist allegedly used the proceeds to buy luxury cars and expensive jewelry. The pharmacist’s scheme lasted nearly three years, from 2015 to 2018.
• A doctor in New York was convicted following an eight-week trial for his role in a Medicare fraud scheme. According to evidence presented at trial, the doctor worked at a clinic that operated under three different corporate names. The doctor submitted claims to Medicare for patient services that were never performed or were medically unnecessary. The claims to Medicare were for a variety of procedures; office visits, physical therapy, and lab testing. Evidence also showed the doctor had a secret kickback room in his clinic where he bribed Medicare beneficiaries to receive medically unnecessary procedures. The doctor paid around $500,000 in illegal bribes. The total fraud amount of this scheme was $77 million.
• A New York doctor was convicted by a federal jury for his role in a Medicare fraud scheme. According to trial evidence, the doctor worked at various New York hospitals and billed Medicare for never performed procedures. The doctor wrote false patient reports and sent the reports to his billing company out of state. He then directed that the services listed in the fake reports be billed to Medicare. The doctor was convicted of one count of healthcare fraud, three counts of making false statements, and two counts of money laundering. The doctor was sentenced to 156 months in prison for his role in the offense.
• A doctor in New York pleaded guilty to his involvement in a Medicare fraud scheme. According to the plea agreement, the doctor worked in a clinic where he falsified patient records to make patients eligible for Medicare reimbursable procedures for which they otherwise would not qualify. The doctor billed Medicare for physical therapy, vitamin infusions, and occupational therapy services that were not reimbursable. As a result of this scheme, Medicare paid out $14 million for the fraudulent services. The doctor pleaded guilty to one count of conspiracy to commit healthcare fraud.
• The owner of two medical clinics in New York pleaded guilty for her involvement in a Medicare fraud scheme. According to the plea agreement, the owner paid cash kickbacks to patients in order to subject them to unnecessary medical treatment. The medically unnecessary treatments were then submitted for payment from Medicare. As a result of the scheme, Medicare paid more than $55 million. The doctor pleaded to conspiracy to commit healthcare fraud and conspiracy to commit money laundering.

Federal prosecutors in New York are known for their constant targeting of healthcare business owners and physicians. More than in most other states, New York prosecutors claim healthcare fraud including Medicare fraud, Medicaid fraud, illegal kickbacks, opioid violations, and much more. The sentencing in New York Medicare fraud cases largely depends on Federal Sentencing Guidelines. Typically, the higher the damage amount to Medicare/CMS, the longer the sentence.