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NYC Health Care Fraud Lawyers

Defend Health Care Fraud Charges with a Winning Legal Team

Under the Health Insurance Portability and Accountability Act of 1996, also known as HIPAA, heath care fraud is considered a federal offense. Being charged with this type of fraud carries a prison sentence of up to 10 years. Seeking experienced legal advice immediately is recommended if you are accused of health care fraud, or even if you suspect that you are under investigation.

What is Health Care Fraud?

Health care fraud is classified as a white collar crime where filing dishonest health care claims are made to receive a profit. Schemes involving this type of fraud comes in many different forms. Practitioner schemes may involve a host of situations such as:

• Modifying medical records
• Intentionally not reporting accurate diagnoses or procedures to maximize the amount of a payment
• Using unlicensed staff
• Using fully covered or subsidized prescription medication that is not needed to sell for a profit on the black market
• Filing duplicate claims for one service rendered
• Billing practitioners when services for that care was never rendered
• Altering description, dates or identities of members regarding services
• Giving or accepting kickbacks for referrals
• Billing services not usually covered as a covered service
• Prescribing treatment that is not necessary to render care

Not only are providers and practitioners subject to charges, but members of insurance programs can also commit health care fraud. Some actions noted are using transport benefits for nonmedical reasons, selling prescription drugs, providing false information when applying for health services or programs and loaning an insurance card or using someone else’s insurance card.

Once an act of health care fraud is perpetrated, the provider passes the costs to customers. The pervasiveness of this type of fraud has led to statistics where 10 cents of every dollar in health care goes toward paying for fraudulent claims.

How Attorneys Assist You with Fraud Matters

Many times, individuals who get arrested for perpetrating the health care system are unaware that they behavior was actually illegal. In some situations, the individual is inadvertently caught up in a fraud scheme.

Unfortunately, the law does not recognize ignorance of the law as a defense. If you are being investigated for possible health care fraud, you should speak with a skilled criminal defense attorney familiar with the types of cases related to this matter. None of the behaviors that constitute health care fraud in New York should be taken lightly.

Defending Health Care Fraud Charges

The criminal lawyers at Raiser & Kenniff, PC offers skilled legal counsel when you are facing charges for all types of fraud, including health care. We can assist you with these issues pertaining to your case:

• Pleading requirements regarding the five degrees of health care fraud in New York. The prosecution must prove that a defendant acted with the intent to defraud. Also pertinent is proving that a defendant knowingly and willfully providing information that was false in order to request and receive an excessive payment from a health plan for a service or item.
• Discovery issues focused on the health and diagnosis of one or more individuals. This is because most fraud claims are related to either false or exaggerated medical conditions.
• Key witness testimony. Medical doctors and insurance experts are usually the most reliable witnesses in a health care fraud case.

We Help You Build a Strong Defense

It is possible to build a strong defense against charges of fraud in a health care case with the right legal team by your side. With 30-years plus of combined experience, Raiser & Kenniff, PC is the firm you can trust. Respected and knowledgeable, our team works tirelessly to defend clients’ reputation against fraud charges.


With 100 years of combined experience, Raiser & Kenniff, is the place to turn when you or a loved one are accused of a crime. When the media needs professional and accurate legal insight on criminal cases in the national spotlight they turn to Raiser & Kenniff.


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