NYC Healthcare Fraud Defense Lawyer

Healthcare fraud is one of the most heavily investigated white-collar crimes in the country, and a federal healthcare fraud conviction can carry up to 10 years in prison per count, or longer if a patient was harmed, along with enormous fines, restitution, loss of your license, and exclusion from Medicare and Medicaid. Doctors, pharmacists, clinic and lab owners, home health and hospice providers, medical device companies, billing companies, and executives can all become targets, often through data analytics that flag billing patterns before anyone is even contacted. Because these cases turn on proving intent, they are frequently defensible, but only with the right lawyer and an early start. If you are under investigation or charged in New York City, an experienced healthcare fraud attorney should be your first call.

Varghese & Associates, P.C. is a federal criminal defense firm on Wall Street, in the heart of the Southern District of New York, and the firm is led by Vinoo Varghese, a former prosecutor and one of the most recognized criminal defense attorneys in the country. Our healthcare fraud attorneys handle these matters in house, from the first audit, subpoena, or agent visit through investigation, indictment, trial, sentencing, and appeal, and they defend the license and billing consequences that come with them. Matters are not routed out to other firms.

Call now for a confidential consultation with a New York City healthcare fraud lawyer. The earlier our healthcare fraud defense lawyers are involved, the more they can do.

What Is Healthcare Fraud?

Healthcare fraud is the crime of knowingly using deception to obtain money from a healthcare benefit program or insurer, such as billing for services that were not provided, billing for more than was provided, paying or receiving kickbacks for referrals, or providing medically unnecessary services. At the federal level it is charged under the healthcare fraud statute and a group of related laws, and it is prosecuted by dedicated Department of Justice strike forces. The defining element is intent, meaning the government must prove you knowingly participated in a scheme to defraud, not that you made a billing error or a good-faith coding mistake. That intent requirement is where an experienced healthcare fraud attorney concentrates the defense.

How Are Healthcare Fraud Cases Investigated in New York City?

Healthcare fraud is investigated by the FBI, the Department of Health and Human Services Office of Inspector General (HHS-OIG), the DEA, and Medicaid Fraud Control Units, working through DOJ healthcare fraud strike forces that use billing-data analytics to identify outliers. Many cases begin as a civil audit or a records request and quietly turn criminal, or start with a whistleblower filing a False Claims Act suit under seal. The first sign for many providers is an audit, a subpoena for records, or a visit from federal agents. That early moment is the most valuable time to bring in a healthcare fraud attorney, because the response can keep a matter civil, protect your license, and sometimes head off charges before an indictment.

The Healthcare Fraud Cases Our Defense Lawyers Handle

Healthcare fraud covers a wide range of specific matters, and each has its own in-depth page explaining the charges, penalties, and defenses. Start with the area that fits your situation, or call to speak with a healthcare fraud lawyer directly.

Program and Billing Fraud

• Medicare fraud defense, including Medicare audits.
• Medicaid fraud defense, including Medicaid audits.
• Medical billing fraud.
• Durable medical equipment (DME) fraud.
• Healthcare audits of all types.

Prescription, Opioid, and DEA Matters

• Opioid prescription investigations.
• DEA investigations and registration defense.
• Prescription error matters.

Professional License Defense

• Medical license defense and medical board matters.
• Nursing license defense.
• Pharmacist license defense.
• Psychologist license defense.
• Physician assistant defense.
• Defense for dentists.

What Are the Federal Healthcare Fraud Statutes?

Healthcare fraud is charged under a group of federal statutes, and prosecutors often use several at once alongside conspiracy and money laundering. The core provisions include:

• Healthcare fraud (18 U.S.C. § 1347)
• False statements relating to healthcare matters (18 U.S.C. § 1035)
• Theft or embezzlement in connection with healthcare (18 U.S.C. § 669)
• Federal Anti-Kickback Statute, for paying or receiving value for referrals (42 U.S.C. § 1320a-7b(b))
• The civil False Claims Act, which often runs alongside a criminal case (31 U.S.C. §§ 3729 through 3733)
• Conspiracy to commit healthcare fraud (18 U.S.C. § 1349)

What Are the Penalties for Healthcare Fraud?

Federal healthcare fraud carries up to 10 years in prison per count, up to 20 years if the violation resulted in serious bodily injury, and up to life if it resulted in death, along with heavy fines, restitution, and forfeiture. Sentences are calculated under the United States Sentencing Guidelines, where the biggest driver is the intended or actual loss, so the amount the government attributes to the alleged scheme controls much of the exposure. Contesting that loss figure, which prosecutors often inflate by treating every claim as fraudulent, is one of the most valuable fights in a healthcare fraud case.

What Happens to My License and Ability to Bill Medicare and Medicaid?

A healthcare fraud investigation can threaten your professional license and your ability to bill federal programs even before any criminal conviction, because a conviction or certain settlements can trigger mandatory exclusion from Medicare and Medicaid and discipline by your licensing board. That is why healthcare fraud defense is not only about avoiding prison. It is also about protecting your career. Our healthcare fraud attorneys coordinate the criminal defense with the license and exclusion consequences, working to prevent a criminal case from ending a career, and defending the related board and program actions.

What Are the Defenses to Healthcare Fraud?

Healthcare fraud turns on intent, and that is where the defenses concentrate. Every case is different, but the strategies our healthcare fraud lawyers commonly use include:

• No intent to defraud. Billing errors, coding mistakes, and good-faith disagreements about medical necessity are not crimes.
• Medical necessity. Showing that the services were appropriate and supported by the provider's clinical judgment.
• Good-faith reliance. Reasonable reliance on billing staff, coders, or compliance advice can negate the required intent.
• Attacking the loss and extrapolation. Challenging the government's sampling and extrapolation methods, which often overstate the alleged loss.
• Suppression. Where records were obtained through an unlawful search or subpoena, moving to suppress under the Fourth Amendment.

What Should You Do If You Are Under Investigation for Healthcare Fraud?

If you learn you are under investigation for healthcare fraud, or receive an audit letter, subpoena, or visit from agents, do not talk to investigators, do not turn over records without counsel, and do not alter or destroy any documents. Call a healthcare fraud attorney immediately. Anything you say can be used against you, and altering records after an investigation begins can create a separate obstruction charge. You have the right to remain silent and the right to counsel. Preserve everything, say nothing without counsel, and let your lawyer engage the auditors and prosecutors.

How Our Healthcare Fraud Attorneys Can Help You

Our healthcare fraud defense lawyers defend these matters at every stage, and they look for the earliest possible point at which the case can be won or shrunk:

• Early intervention. Responding to audits, subpoenas, and target letters to keep a matter civil where possible and to negotiate a declination or reduced charges before an indictment.
• Protecting your license and billing privileges. Coordinating the criminal defense with licensing-board and Medicare or Medicaid exclusion proceedings.
• Fighting the loss and extrapolation. Using forensic and clinical experts to challenge the government's damages and sampling methods.
• Motion practice and trial. Moving to dismiss defective counts, suppressing unlawfully obtained evidence, and trying cases before federal judges and juries.
• Sentencing and appeal. Challenging the loss calculation, arguing for variances, and pursuing appeals and post-conviction relief.

Is Healthcare Fraud a Felony?

Yes. Federal healthcare fraud is a felony, punishable by up to 10 years in prison per count, and up to 20 years or life if a patient suffered serious bodily injury or death. Even beyond prison, a conviction brings fines, restitution, forfeiture, loss of licensure, and exclusion from federal healthcare programs, which can permanently end a medical career. That combination of criminal and professional exposure is why every healthcare fraud allegation should be treated as serious from the start.

How Much Does It Cost to Hire a Healthcare Fraud Lawyer in New York City?

The cost of a healthcare fraud lawyer in New York City depends on whether the matter is a civil audit or a criminal case, the volume of billing and medical records, whether a parallel False Claims Act case exists, and whether the matter resolves before or goes to trial. These cases involve extensive record review, forensic and clinical analysis, and detailed motion practice, so they require real work. Our healthcare fraud attorneys are transparent about fees from the first conversation and structure the representation to fit the matter. Given the prison exposure and the threat to your license and livelihood, the more important question is usually what an inadequate defense can cost you.

A Healthcare Fraud Attorney the National Media Turns To

When the biggest federal cases in the country are in the news, networks and newspapers call Vinoo Varghese to explain what is really happening in the courtroom. That is the same judgment and credibility our healthcare fraud attorneys bring to your case.

Vinoo Varghese has provided legal analysis and commentary for CBS News, Fox News, Fox Business, CNN, MSNBC, Court TV, HLN, BBC, Inside Edition, i24 News, Sky News Arabia, and Nancy Grace's Crime Stories, and has hosted true-crime legal analysis for Vanity Fair. He has been quoted as a legal authority by The New York Times, The Wall Street Journal, the New York Law Journal, Law360, the New York Daily News, and the New York Post. A former prosecutor from the Brooklyn District Attorney's Office, he is a nine-time National Trial Lawyers Top 100 honoree, an eight-time New York Metro Super Lawyer, rated AV Preeminent by Martindale-Hubbell, and has served on the visiting faculty of Harvard Law School's Trial Advocacy Workshop.

Contact a New York City Healthcare Fraud Lawyer Now

If you are under investigation, are facing an audit that may be turning criminal, have received a subpoena, or have been charged with healthcare fraud anywhere in New York City, do not wait and do not talk to anyone but your lawyer. Speak with a healthcare fraud attorney who has stood in the courtroom, tried the cases, and earned the national platform that comes with real results.

Call Varghese & Associates, P.C. for a confidential consultation. Our office is located at 2 Wall Street, Suite 310, New York, NY 10005, steps from the federal courthouses of the Southern District of New York.

Attorney Advertising. Prior results do not guarantee a similar outcome. The information on this page is for general educational purposes and is not legal advice. Contacting the firm does not create an attorney-client relationship.