NY Penal Law § 177.10: Health care fraud in the fourth degree

Healthcare fraud is a type of white collar crime that involves submitting false medical claims in order to receive payment from a health plan or health insurance company. Health care fraud usually takes the form of a doctor submitting claims to insurance companies for procedures that were not performed or that were not fully performed. However, health care fraud can also involve dentists, chiropractors, pharmacists, ambulance company operators, as well as other employees or owners of companies that submit claims to health plans for payment. There are 5 offenses related to health care fraud: health care fraud in the first, second, third, fourth and fifth degrees. The specific crime that you will face depends on the amount of money you received as a result of the fraud in a single year. Under New York Penal Law § 177.10, you could be charged with health care fraud in the fourth degree if you knowingly submit false a health care claim or heath care claims, and as a result you received payments to which you were not entitled. The payments must be from a single plan and must total more than $3000, but not more than $10,000.

Dr. Jerome, an internal medicine physician, submitted bills to a single insurance company that indicated that he saw on average 50 patients a day. This was an immediate red flag to the insurance company as it would be unusual for a single doctor to see that many patients in one day. After sending out payments for a few of the bills, the insurance company halted payment and launched an investigation. It discovered that many of the claims were duplicates. Dr. Jerome could be convicted of health care fraud in the fourth degree only if the prosecutor can show that Jerome knowingly submitted duplicate bills and that the total amount of fraudulent claims for which he received payment was more than $3,000.

1. Health care fraud in the fifth degree: New York Penal Law § 177.05
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

If you did not knowingly submit fraudulent claims, then you cannot be convicted for health care fraud in the fourth degree. For example, if there was a technical problem that resulted in your computer submitting the same claims multiple times, then there would not have been fraud.

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 fourth degree is a class E felony. If you are convicted of this offense you could be sent to prison for up to 4 years. You could also receive a probation sentence of up to 5 years. The financial consequences of a conviction may be that you will be required to pay restitution as well as a substantial fine.

A person is guilty of health care fraud in the fourth degree when such person, on one or more occasions, commits the crime of health care fraud in the fifth degree and the payment or portion of the payment wrongfully received, as the case may be, from a single health plan, in a period of not more than one year, exceeds three thousand dollars in the aggregate.

If you are under investigation for health care fraud it is imperative that you immediately seek experienced representation. A health care fraud conviction will not only jeopardize your career, it may also result in you going to prison. 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.