Differences Between Civil and Criminal Healthcare Fraud

There are substantial differences between civil and criminal healthcare fraud claims in New York. Civil healthcare fraud often involves allegations that patients or providers unlawfully obtained medical benefits from a federal healthcare scheme (Medicare or Medicaid). Criminal healthcare fraud charges carry significant penalties, including prison time, and can result in substantial harm to a patient or insurer.

If you’re facing healthcare fraud charges in New York state or federal court, you need healthcare fraud defense lawyer Peter Katz. Confidentially contact his NY federal criminal defense team today online or at (609) 849-3179.

Understanding Civil Healthcare Fraud Lawsuits

In New York, civil healthcare fraud most commonly involves claims that a medical service provider submitted fraudulent billing information to a state or federal health insurer. Civil lawsuits for healthcare fraud, often filed under the False Claims Act (FCA), demand the return of all money the provider unlawfully obtained. The civil branch of the federal or state prosecutor’s office might litigate these claims, or a healthcare fraud whistleblower could file the lawsuit on the government’s behalf. FCA healthcare whistleblowers are entitled to certain federal protections and might recover up to 30% of any money recovered.

Civil fraud claims do not always involve criminal elements, as some billing companies may make good-faith mistakes during the complex medical coding process. However, high-value civil claims often indicate the healthcare provider intentionally engaged in fraudulent conduct and commonly give rise to criminal healthcare fraud charges.

Defending Against Criminal Healthcare Fraud Charges in New York

Healthcare fraud carries federal criminal penalties under 18 U.S.C. § 1347. The statute criminalizes any knowing and willful scheme to either defraud a healthcare benefit program or fraudulently obtain healthcare benefits, including claims payments. Unlike related civil claims, criminal charges require intent. The beneficiary, whether an individual applying for Medicaid or a hospital seeking payment, must knowingly and intentionally submit false information to the health insurance provider. Defending against 18 U.S.C. § 1347 charges often involves demanding that the government provide evidence of intent, not just billing mistakes or legal misunderstandings.

Penalties Associated with Civil and Criminal Healthcare Fraud Claims

You should always speak with an experienced NY healthcare fraud lawyer about potential liability, but civil and criminal claims generally carry the following consequences:

Civil Healthcare Fraud (FCA)

Money damages are the only remedy for civil healthcare fraud claims under the FCA. In appropriate cases, the court will enter a monetary judgment for the following: 

• Reimbursement for all fraudulently obtained benefits
• Interest
• Attorneys’ fees
• Litigation expenses and court costs

If you cannot pay the judgment, the court also has the authority to seize your assets.

Federal Criminal Healthcare Fraud (18 U.S.C. § 1347)

If convicted under 18 U.S.C. § 1347, defendants may face up to 10 years in prison, restitution (repayment), fines, and asset forfeiture. Medical professionals might also face additional consequences from the AMA or state licensure board. Fraud resulting in bodily injury could result in up to 20 years in prison, and fraud resulting in death could be punishable by life in prison. These are serious charges in New York, necessitating the services of an experienced federal criminal defense lawyer.

Experienced Healthcare Fraud Defense Attorney in New York

Whether you suspect your employer is engaging in unlawful medical billing practices or you’ve been charged with criminal healthcare fraud in NY, you need a dedicated white-collar defense lawyer, Peter Katz. Call (609) 849-3179 or connect with his defense team online to confidentially discuss your case.