NY Penal Law § 177.15: Health care fraud in the third degree

Health care fraud is a 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, dentist, chiropractor, or pharmacist submitting claims to insurance companies for services, products or medications that were never given to patients. 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 received as a result of the fraud. Under New York Penal Law § 177.15 you would have committed health care fraud in the third 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 amount of payments must be from a single plan and must total more than $10,000, but not more than $50,000.

Andrew Jones was a pharmacist. It was rumored that he sold prescription medications to people who did not have prescriptions. The police launched an investigation. On 3 different occasions undercover police officers went to Jones' pharmacy and asked to buy codeine, Ritalin, and Valium without prescriptions. Based on these transactions, the police executed a search warrant on Jones' pharmacy. Investigators found that Jones submitted bills to a health plan in the names of other people in order to get payment for the prescription drugs he dispensed illegally. Jones was charged with health care fraud in the third degree as investigators found that he had received $45,000 in payments from a single health plan from fraudulent submissions.

1. Health care fraud in the fifth degree: New York Penal Law § 177.05
2. Health care fraud in the fourth degree: New York Penal Law § 177.10
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

In order for you to be convicted of health care fraud in the third degree, the prosecutor must have proof that you received payments for fraudulent claims from a single health plan in a single year that totaled more than $10,000, but not more than $50,000. If, for example, you submitted claims that were not legitimate, but the insurance company never sent you payment, you cannot be convicted of health care fraud.

In addition, if you did not knowingly submit fraudulent claims, then you cannot be convicted for health care fraud in the third degree. For example, if there was a technical problem that resulted in the computer submitting the same claims multiple times without your knowledge, then there would not have been fraud.

Health care fraud in the third degree is a class D felony. If you are convicted of this offense you could be sent to prison for up to 7 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 repay the money obtained through the fraud, and you may be required to pay a substantial fine.

A person is guilty of health care fraud in the third 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 in the third degree it is imperative that you immediately seek experienced representation. A health care fraud conviction will not only jeopardize your career and cause you and your family great financial stress, 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.