Health Care Fraud in New York

Health care fraud has become a multi-billion dollar industry in the United States, affecting both private insurance as well as federal programs such as Medicare. In 2011 alone, federal investigators recovered over $4 billion in health insurance fraud money.

As a result, we were not completely surprise by a recent press release from the United States Department of Justice reporting that a Brooklyn board-certified colorectal surgeon had been convicted of insurance fraud. The physician, Boris Sacharov, was found guilty after a jury trial of one count of health care fraud and five counts of health care false statements. At trial, evidence was presented that between 2008 and 2010 Dr. Sacharov submitted false claims to both Medicare and private health insurance companies totaling $22.6 million, $9 million of which was paid. He faces a maximum of 35 years in prison and a fine of $18 million.

What Are the Criminal Laws Relating to Health Care Fraud?

Health care fraud is a crime under both federal law and New York law, but wading through the various criminal laws can be confusing for those who are not experienced in the area. We though our readers would be interested in a brief explanation of some of the applicable statutes.

Federal Laws

The primary federal health care fraud law is contained in the Health Insurance Portability and Accountability Act of 1996 (HIPPA). It applies to fraud against private health insurers and government health programs. It also applies to any other program that provides health insurance, including automobile insurance and workers’ compensation. The statute is violated when a person knowingly and willfully engages, or attempts to engage, in a scheme to defraud any health care benefit program, or obtains any property from a health care program by false representations. The penalty for a violation of the statute is generally a maximum of ten years in prison. HIPPA also makes it a crime to falsify or conceal a material fact, make a false statement, or utilize a false document in connection with obtaining payment for health care services. A violation of this section can lead to a maximum sentence of five year in prison.

In addition, health insurance fraud may constitute a violation of a number of other federal laws, among them mail fraud, wire fraud, the Racketeer Influenced and Corrupt Organization Act (RICO), the False Claims Act, the False Statements to a Government Agency law, and others.

New York Laws

The primary health care fraud statute in New York is contained in Article 177 of the Penal Law, which deals specifically with health care fraud, and is applicable to both government and private health insurance. The basic crime consists of knowingly filing a health insurance claim with intent to defraud. The filing alone constitutes health care fraud in the 5th degree, and is a Class A misdemeanor. There are four additional gradations, which depend upon the amount of money received annually as a result of the false filings, and they run as high as a Class B felony (insurance fraud in the 1st degree) for claims in excess of $1 million.

PL176, covering insurance fraud in general, may also be applied to fraudulent claims for health insurance payments. Other New York laws that may be involved are violations of the Social Services law (making false statements to receive medical assistance for oneself or another); larceny; falsifying business records; and presenting a false instrument for filing.

What Should I Do if I am Charged with Health Care Fraud?

If you are facing a charge of health care fraud, contact an experienced New York fraud lawyer to defend your rights. Call us for a free consultation.

George Vomvolakis Law Offices
275 Madison Avenue
New York, NY 10016
(212) 682-0700