What Are the Penalties for Medicare Fraud in New York?
Find Out (For Free) Why New Yorkers Hire Defense Attorney Dr. Nick Oberheiden 866-Hire-Nick
It is a tough time to be a doctor in New York. Almost no day goes by without published stories about new health care fraud allegations, indictments, arrests, search warrants, and other government pressure targeted against NY health care business owners and providers. Your choice should be easy. You can either risk being added to the ever-growing list of defendants, or you can choose lawyers that have successfully defended New York surgeons, cardiologists, pain management, family, internal medicine, and so many other New York medical specialists and entrepreneurs in grand jury investigations, health care audits, and federal fraud investigations. We have successfully represented:
- Mobile Ambulance Transportation Cases
- Mobile Radiology Services
- Home Health Care Agency (Form 485 Cases)
- Hospice Care Representation
- Illegal Kickbacks
- Any Form of Medicare Fraudulent Billing
- Mental Health Care Providers
- Dialysis Centers
- Family Medicine Doctors
- Internal Medicine Specialists
- Pain Management Doctors
- Medicare Clinic Owners
Speak with New York Federal Criminal Defense Attorney Dr. Nick Oberheiden on Weekends or Today: 866-Hire-Nick
Unlike any law firm you will find, Oberheiden PC almost exclusively focuses its practice to protect and defend health care providers. We don’t mix DUI defense and rape defense into our practice like other lawyers because we believe that understanding health care laws and providing effective defense strategies must be more than just a hobby. In hundreds of health care cases, we have defended physicians and health care businesses against every imaginable fraud allegation—virtually across the entire United States and New York.
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What Are the Penalties for Civil Medicare Fraud in New York?
In civil Medicare fraud cases, where the government does not base its case on (criminal) intent, federal authorities like the Office of Inspector General, have statutory authority to sanction non-criminal Medicare fraud with civil liability on individuals and companies.
If your New York business received a subpoena from the Department of Health and Human Services, Office of Inspector General, then 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 recently increased from previously $ 10,000 to now $ 20,000 per false claim.
Nick Oberheiden has avoided liability for clients in New York and elsewhere in dozens and dozens of civil fraud cases. Call him directly and today at 866-Hire-Nick to hear what he would do to protect your business and your 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 health care 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 health care benefit program or obtain money or property from a health care 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 health care benefit program; and
- The defendant acted with the intent to defraud the health care benefit program.
Because health care fraud and Medicare fraud are federal offenses, 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), and prosecuted by Assistant United States Attorneys from the U.S. Attorney’s Office. New York State is divided into four federal court districts.
- Northern District of New York covering the counties of Albany, Broome, Cayuga, Chenango, Clinton, Columbia, Cortland, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Herkimer, Jefferson, Lewis, Madison, Montgomery, Oneida, Onondaga, Oswego, Otsego, Rensselaer, Saint Lawrence, Saratoga, Schenectady, Schoharie, Tioga, Tompkins, Ulster, Warren, and Washington.
- Eastern District of New York covering the counties of Kings, Nassau, Queens, Richmond, and Suffolk.
- Western District of New York covering the counties of Allegany, Cattaraugus, Chautauqua, Chemung, Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans, Schuyler, Seneca, Steuben, Wayne, Wyoming, and Yates.
- Southern District of New York covering the counties of Bronx, Dutchess, New York, Orange, Putnam, Rockland, Sullivan, and Westchester.
What Are the Penalties for Criminal Medicare Fraud in New York?
If you have any questions or concerns or need to better understand the penalty calculation for Medicare Fraud in New York or need to get guidance for an upcoming sentencing hearing—then call Oberheiden PC today for a free and confidential consultation. We are available on weekends. Avoid these consequences, call 866-Hire-Nick
- A New York pharmacist was indicted for her role in a scheme to defraud Medicare. According to the indictment, the pharmacist owned two pharmacies and would submit bills to Medicare for reimbursement for drugs that were either medically unnecessary or were 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 based on the fraudulent claims. The pharmacist allegedly used the proceeds to buy luxury cars and expensive jewelry. The scheme the pharmacist ran lasted approximately three years, from 2015 to 2018.
- A doctor in New York was convicted following an eight-week trial in federal court 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 would submit claims to Medicare for patient services that were never performed or medically unnecessary. The claims billed to Medicare were for a variety of procedures, including office visits, physical therapy and lab testing. Evidence also showed that the doctor had a secret kickback room in his clinic where he would pay Medicare beneficiaries bribes in order to receive medically unnecessary procedures. Approximately $500,000 in illegal bribes was paid by the doctor. 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 evidence presented at trial, the doctor worked at various New York hospitals and would bill Medicare for procedures that were never performed. The doctor would write fake patient reports and then send the reports to his billing company out of state and ask the services listed in the fake reports be billed to Medicare. The jury convicted the doctor of one count of health care fraud, three counts of making false statements related to health care matters 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 a clinic and would falsify patient documentation to make patients eligible for Medicare reimbursable procedures that they otherwise would not qualify for. 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 health care fraud.
- The owner of two medical clinics in New York pleaded guilty for her involvement in a scheme to defraud Medicare. According to the plea agreement, the owner of the clinics would pay cash kickbacks to patients in order to subject them to unnecessary medical treatment. The medically unnecessary treatments would then be submitted for reimbursement to Medicare. As a result of the scheme, Medicare paid more than $55 million. The doctor pleaded to conspiracy to commit health care fraud and conspiracy to commit money laundering.
Federal prosecutors in New York are known for their relentless targeting of health care business owners and physicians licensed to practice in New York State. More than in most other states, New York prosecutors claim health care fraud including Medicare Fraud, Medicaid Fraud, illegal kickbacks, opioid violations, and much more. The sentencing in New York Medicare Fraud cases largely depends on the calculated recommendations under the Federal Sentencing Guidelines. Generally speaking, the higher the damage amount to Medicare/CMS, the higher the sentence.