Medicaid Fraud Criminal Charges: Scheme to Defraud in the First Degree
Scheme to Defraud in the First Degree is one of the most serious criminal charges you can face for Medicaid Fraud in New York. It is found in New York Penal Law Section 190.65.
The crime is a Class E felony. If convicted, you may be sentenced to up to four years in prison, a fine of up to $5,000 or double your gain from committing the offense, and three to five years of probation. If you are a medical professional, you may also have your professional license revoked or suspended. A conviction will result in mandatory exclusion from the Medicare and Medicaid programs.
In order to prove a charge of Scheme to Defraud in the First Degree, prosecutors must prove beyond a reasonable doubt one of the following three variations: (a) that you defrauded ten or more persons; or (b) that you defrauded more than one person and obtained money or property worth more than $1,000; or (c) that you defrauded one or more vulnerable elderly persons. The Medicaid program and Medicaid managed care companies are considered “persons.”
Prosecutors must also prove that you had the specific intent to defraud. Mistakes, negligence, and even gross negligence are not sufficient to convict you of this crime. This is where an experienced Medicaid fraud attorney can be critical to your defense. Many cases are decided based on the complex billing rules and regulations for Medicaid claims and the often confusing methods for processing those claims.
Individuals who are charged with Scheme to Defraud in the First Degree are usually charged with other crimes as well, including Grand Larceny, Criminal Possession of Stolen Property, Criminal Possession of a Forged Instrument, Forgery, and Falsifying Business Records.
Time is not on your side. If you are being audited or investigated for Medicaid fraud, or if you are facing arrest and criminal charges, you need an experienced Medicaid fraud lawyer to help you develop your defenses and evidence immediately.
John Howley, Esq. has represented healthcare clients in complex criminal investigations, trials and appeals for more than 30 years. Call him directly at 212-601-2728 to schedule a consultation.
The crime is a Class E felony. If convicted, you may be sentenced to up to four years in prison, a fine of up to $5,000 or double your gain from committing the offense, and three to five years of probation. If you are a medical professional, you may also have your professional license revoked or suspended. A conviction will result in mandatory exclusion from the Medicare and Medicaid programs.
In order to prove a charge of Scheme to Defraud in the First Degree, prosecutors must prove beyond a reasonable doubt one of the following three variations: (a) that you defrauded ten or more persons; or (b) that you defrauded more than one person and obtained money or property worth more than $1,000; or (c) that you defrauded one or more vulnerable elderly persons. The Medicaid program and Medicaid managed care companies are considered “persons.”
Prosecutors must also prove that you had the specific intent to defraud. Mistakes, negligence, and even gross negligence are not sufficient to convict you of this crime. This is where an experienced Medicaid fraud attorney can be critical to your defense. Many cases are decided based on the complex billing rules and regulations for Medicaid claims and the often confusing methods for processing those claims.
Individuals who are charged with Scheme to Defraud in the First Degree are usually charged with other crimes as well, including Grand Larceny, Criminal Possession of Stolen Property, Criminal Possession of a Forged Instrument, Forgery, and Falsifying Business Records.
Time is not on your side. If you are being audited or investigated for Medicaid fraud, or if you are facing arrest and criminal charges, you need an experienced Medicaid fraud lawyer to help you develop your defenses and evidence immediately.
John Howley, Esq. has represented healthcare clients in complex criminal investigations, trials and appeals for more than 30 years. Call him directly at 212-601-2728 to schedule a consultation.
