NY Penal Law § 177.05: Health care fraud in the fifth degree

Healthcare fraud is a type of white collar crime crime that involves submitting false medical claims in order to receive payment from a health plan or health insurance company. For example, if a physician submits a claim to an insurance company for a procedure that he or she never performed in order to receive payment for that procedure and then receives payment from the insurance company, that physician would have committed health care fraud. There are 5 offenses related to health care fraud: health care fraud in the first, second, third, fourth and fifth degrees. Health care fraud in the fifth degree is the least serious of the 5 charges and is the only one that is a misdemeanor. Under New York Penal Law § 177.05, you could be charged with health care fraud in the fifth degree if you knowingly submit false a health care claim and as a result you received payments to which you were not entitled. The amount of payments must be less than $3000.

Dr. Gene Franklin, a chiropractor, noticed a downturn in his business. To make up for the loss in receivables, Franklin began to inflate the bills he submitted to health plans for payment. He billed plans for services that were not reimbursable, for services that were not provided, and for services that were fully provided. In order to avoid getting caught, the amount of each fraudulent submission was very small. However, he did get caught. Franklin could be charged with health care fraud in the fifth degree if the amount of payments he received as a result of the fraudulent submissions did not exceed $3000.

1. Health care fraud in the fourth degree: New York Penal Law § 177.10
2. Health care fraud in the third degree: New York Penal Law § 177.15
3. Health care fraud in the second degree: New York Penal Law § 177.20
4. Health care fraud in the first degree: New York Penal Law § 177.25

Under New York Penal Law § 177.30, you cannot be prosecuted for health care fraud if you were a bookkeeper, clerk or other employee besides a manager who merely executed the orders of your supervisor without receiving any personal benefit.

Health care fraud in the fifth degree is a class A misdemeanor. If you are convicted of this offense you could be sent to jail for up to a year. You could also receive a probation sentence of up to 3 years and be required to pay a fine.

A person is guilty of health care fraud in the fifth degree when, with intent to defraud a health plan, he or she knowingly and willfully provides materially false information or omits material information for the purpose of requesting payment from a health plan for a health care item or service and, as a result of such information or omission, he or she or another person receives payment in an amount that he, she or such other person is not entitled to under the circumstances.

Even though health care fraud in the fifth degree is not a felony, you should take the charge seriously. If you are convicted part of your sentence could include up to a year in jail. The staff at the Law Offices of Stephen Bilkis & Associates has years of experience successfully defending clients in New York criminal courts who have been charged with fraud, grand larceny, white collar crimes, and other serious crimes. Contact us at 800.696.9529 to schedule a free, no obligation consultation regarding your case. We serve those accused of larceny in the following locations: the Bronx, Brooklyn, Long Island, Manhattan, Nassau County, Queens, Staten Island, Suffolk County and Westchester County.