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Theft by Healthcare Fraud

There are many frauds and crimes perpetrated in New York State where the goal and object of the alleged fraudster is to pocket money he or she is not entitled. Sometimes a theft or larceny is a “simple” embezzlement type of offenses while other times law enforcement, such as the Attorney General of the State of New York, the Brooklyn District Attorney’s Office, or any local District Attorney, arrests or indicts a one-person scam or a large scale and multi-headed crew committing various criminal acts. When the crime involves Health Care Fraud, whether it is Health Care Fraud in the Third Degree, First Degree, or any other New York Penal Law Article 177 offense, and the victim of a larceny is not merely the State of New York, but taxpayers, expect that your criminal lawyer will be defending you from the full wrath of law enforcement.

Health Care Fraud: Understanding the Crime and Law

Before diving into the varying degrees of Health Care Fraud in New York and explaining the differences between New York Penal Law 177.25, First Degree Health Care Fraud, and New York Penal Law 177.05, Fifth Degree Health Care Fraud, you must first have an understanding basic terms relevant to the statutes.

Health Plan

New York Penal Law 177.00(1) defines a “health plan” as a privately or publicly funded health insurance or managed care plan, under which any health care item or service is provided and which payment may be made to the person who provided the health care item or service. Medicaid is considered a “health plan” for the purpose of this statute.


Believe it or not, “person” is a statutory term defined in New York Penal Law 177.00(2). Not just its common understanding, “person” means any individual or entity, other than a recipient of a health care item or service under a health plan unless such recipient acts as an accessory to such an individual or entity.

Beyond these definitions, Health Care Fraud is committed when you have an intent to defraud a health plan, such as Medicaid, and in doing so you knowingly and willfully provide materially false information, or omit material information, for the purpose of requesting payment from a health plan for either a health item or a health service. After submitting this information, the health plan then pays you some amount of money, whether in full or not, that you are not entitled to under the circumstances.

The Specific Crimes of Health Care Fraud

New York Penal Law 177.05

The unifying language of each degree of Health Care Fraud stems from that set forth above which is Fifth Degree Health Care Fraud, New York Penal Law 177.05. A class “A” misdemeanor, Fifth Degree Health Care Fraud has no minimum threshold for a financial gain by the wrongdoer.

New York Penal Law 177.10

Once your theft from a Health Plan through wrongly receiving monies exceeds $3,000.00 during a one-year period, the crime becomes a felony of Fourth Degree Health Care Fraud, New York Penal Law 177.10. A class “E” felony, a conviction for Health Care Fraud in the Fourth Degree carries with it a potential sentence of up to four years in prison.

New York Penal Law 177.15

Up on committing Fifth Degree Health Care Fraud in an aggregate amount exceeding $10,000.00, but not more than $50,000.00, the District Attorney in the county where you allegedly committed Health Care Fraud will prosecute you for violating Health Care Fraud in the Third Degree. Third Degree Health Care Fraud, New York Penal Law 177.15, is a class “D” felony and the penalty upon conviction is as much as seven years in a New York State prison.

New York Penal Law 177.20

Growing out from the misdemeanor crime of PL 177.10, Health Care Fraud in the Fifth Degree, when the dollars and ill-gotten gain from a fraudulent health care act or acts is more than $50,000.00 during a period of one year or less, prosecutors will likely present to a Grand Jury the crime of Second Degree Health Care Fraud, New York Penal Law 177.20. A class “C” felony with a penalty of incarceration reaching fifteen years in prison, a conviction for PL 177.20 can only get worse if the theft from a single health plan exceeds $1 million.

New York Penal Law 177.25

The “granddaddy” of all Health Care Fraud, First Degree Health Care Fraud, New York Penal Law 177.25, involves defrauding a single health plan over the course of one year or less in a total amount beyond $1 million. The highest degree crime one can face in the New York Penal Law outside of certain drug felonies and statutorily defined violent crimes, PL 177.25 is a class “B” felony with a mandatory minimum sentence for even a first-time arrestee or offender and a maximum penalty of twenty-five years in prison.

Health Care Fraud: Affirmative Defense

Limited in its scope, New York Penal Law 177.30 establishes an affirmative defense for any degree of Health Care Fraud. If you, as a bookkeeper, clerk or other employee, other than one charged with active management and control, in an executive capacity, without personal benefit, merely executed the orders of your superior generally authorized to direct your activities or employer.

Health Care Fraud: Other Crimes and Considerations

It is fairly routine in Health Care Fraud crimes and schemes to see the District Attorney or New York Attorney General secure an indictment not merely for a particular Degree of Health Care Fraud, but for other related crimes. Sometimes, these crimes are lesser felonies while other times they are more significant. For example, an indictment may include a degree of Grand Larceny, pursuant to New York Penal Law Article 155, Criminal Possession of Stolen Property, pursuant to New York Penal Law Article 165, Forgery, New York Penal Law Article 170, Falsifying Business Records, New York Penal Law Article 175, and depending if the allegation involves a larger criminal organization, Enterprise Corruption, New York Penal Law 460.20.

Your Arrest: Your Future

Health Care Fraud crimes in New York are aggressively investigated and prosecuted by all branches of law enforcement. With bureaus and units formed to specifically fight these thefts, it is common for the police or other agencies to conduct sweeps of targets while executing search warrants at homes, business, banks and other locations. After hauling the accused off to see a judge, it is routine for either the District Attorney or NYS Attorney General to ask a judge to set significant bail with the objective to keep you, the accused, behind bars during the pendency of the criminal case.

With exposure that can leave you imprisoned for as long as one, four, seven, fifteen or even twenty-five years, saddled with restitution and fined to such a magnitude that you and your family could be left functionally and financially destitute, ready yourself to fight for your rights, liberty and future from day one. Because there is no substitute for a criminal defense attorney or team of criminal lawyers with the knowledge and experience to best advocate in your defense, contact the New York Health Care Fraud attorneys and former Manhattan prosecutors at Saland Law.

Call our New York Criminal Defense Attorneys and Health Care Fraud Lawyers at (212) 312-7129 or Contact Us Online Today.

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From the moment I contacted Jeremy Saland he inspired trust and confidence. His honesty and extensive knowledge about the court process made me feel like I was in good hands. He helped make a stressful and difficult experience more manageable and tolerable by clearly informing me on the legal steps we had to take and knowing exactly what to expect for our day in court. Thank you for your professionalism and help Jeremy! I will be eternally grateful. Alexandra
I was arrested and charged with Grand Larceny. I was filmed on surveillance camera and the police was trying to find me for several days. Although I had to spend the night in prison/ tombs he was able to set me free the next morning without bail. A court date was set for August but he was able to negotiate with the DA and after only three weeks I had to appear before court, pay a restitution fine and was sentenced with an ACD for a period of 6 months. Alex
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