NYC Federal Healthcare Fraud Lawyer

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Healthcare Fraud Lawyer In NYC Federal

Healthcare fraud is a serious offense, and it can lead to stiff penalties if convicted. A conviction can affect your career, personal life, reputation, and freedom. Unfortunately, when fraud occurs, many individuals, including physicians, billing administrators, clinical workers, and healthcare representatives, can be suspected of criminal activity. If you are accused of fraud, having a NYC federal healthcare fraud lawyer can help you fight for your future.

Skilled NYC Federal Healthcare Fraud Lawyer

Why Choose The Law Office of Jonathan Savella?

The Law Office of Jonathan Savella is committed to protecting our clients from federal healthcare fraud allegations, and we bring a lot of knowledge to the table. In complicated fraud situations, Jonathan Savella has a track record of effectively defending healthcare institutions and professionals in NYC. Numerous clients have benefited from his vigorous defense tactics and in-depth knowledge of federal healthcare rules.

Protecting your rights, reputation, and livelihood is our priority because we recognize the high stakes in healthcare fraud cases. Each client receives the attention and knowledge required to successfully navigate these difficult legal waters thanks to our individualized approach.

What Is Federal Healthcare Fraud?

Federal healthcare fraud is a crime. It involves knowingly and intentionally submitting incorrect or misleading information for the purposes of receiving benefits, payments, or services from programs like Medicaid, Medicare, or TRICARE. Fraud can occur at any stage in the healthcare process, from diagnosis to billing after treatment. Some common examples of federal healthcare fraud include:

Upcoding. This happens when a healthcare provider sends billing codes for a service that is more expensive than the one they performed, giving them higher reimbursements.
Kickbacks. A kickback occurs when a healthcare provider receives an incentive for referrals. This is against federal regulations as it can lead to bias when making healthcare decisions.
Phantom billing. Phantom billing is billing for services that were never provided, including tests and appointments.
Unnecessary procedures. If a healthcare provider performs a service that was not medically necessary, to receive payment for the service, this is a form of healthcare fraud.
Double billing. This occurs when a healthcare provider bills multiple insurers for the same treatment to be compensated for it more than once.

Federal Healthcare Fraud Statutes

When federal healthcare fraud is suspected, these accusations are heavily pursued. Several federal laws are in place to protect individuals against fraud, including:

The False Claims Act. This act holds providers accountable for knowingly submitting false claims to the government.
Anti-Kickback Statute. This statute forbids providers from receiving financial compensation for patient referrals.
Health Care Fraud Statute. This law criminalizes tactics used to defraud healthcare programs.

Despite these laws in place, federal healthcare fraud accusations are still prevalent. During fiscal year 2023, the Health Care Fraud and Abuse Control Program recovered $3.4 billion from healthcare fraud cases. During a nationwide enforcement effort in 2024, 193 individuals were charged with conspiring to cause planned damages of almost $2.75 billion and $1.6 billion in actual losses.

Why You Need a Federal Healthcare Fraud Lawyer

Being accused of federal healthcare fraud is a serious accusation requiring the legal knowledge of an experienced federal healthcare fraud attorney. These types of cases tend to be complex and multi-layered. Investigations can be extensive, aggressive, and rigorous, with investigations being conducted by multiple government agencies.

A qualified attorney can provide you with protection during the process. They can intervene early to fight for your rights and minimize the penalties against you. They can present evidence to build a strong defense, showing:

Lack of intent. The government must prove that you intended to defraud. It is not considered a criminal act if honest mistakes, errors, or negligence took place.
Insufficient evidence. It is the prosecution’s job to provide evidence of your guilt. If their claims lack evidence to prove wrongdoing, an attorney can argue this point, potentially leading to reduced or dismissed charges.
Governmental misconduct. If government officials did not operate within legal parameters, such as using coercion to get a testimony, entrapment, or performing illegal searches and seizures, evidence may be rendered inadmissible.

In New York City, federal healthcare fraud cases are typically heard in the U.S. District Court for the Southern District of New York, located at 500 Pearl Street, or the Eastern District of New York, located at 225 Cadman Plaza East in Brooklyn.

FAQs

Q: What Is the Crime Fraud Exception to Attorney-Client Privilege in New York?

A: In New York, the crime-fraud exception authorizes courts to override attorney-client privilege when a client seeks legal advice with the intent to further or conceal a crime or fraudulent activity. This exception applies irrespective of whether the attorney was aware of the client’s illicit objectives, provided that the communications in question were made in furtherance of unlawful conduct.

Q: What Are the Federal Laws for Health Care Fraud and Abuse?

A: Federal statutes addressing healthcare fraud and abuse include the False Claims Act, the Anti-Kickback Statute, and the Health Care Fraud Statute. These laws collectively prohibit healthcare providers from submitting falsified claims for reimbursement, offering or receiving illicit inducements for patient referrals, and engaging in fraudulent schemes aimed at financial gain through healthcare programs.

Q: How Serious Is Healthcare Fraud?

A: Healthcare fraud constitutes a significant criminal offense with substantial legal consequences. Convictions may result in incarceration, substantial monetary penalties, and revocation of professional credentials. Such cases are rigorously prosecuted, particularly due to their impact on publicly funded programs and broader implications for public health and trust.

Q: Is Health Insurance Fraud a Federal Crime?

A: Health insurance fraud is categorized as a federal offense when it implicates federal healthcare programs such as Medicare or Medicaid. Engaging in fraudulent billing, making false representations, or executing deceptive schemes to obtain federal healthcare funds unlawfully may prompt federal prosecution. These offenses are subject to investigation by federal agencies, underscoring the importance of legal representation by counsel proficient in healthcare fraud defense.