Health Care Fraud Defense
New York Penal Law 177.25 Health Care Fraud in the First Degree Lawyer
Lebedin Kofman LLP defends people, professionals, providers, business owners, and licensed individuals facing New York Penal Law 177.25 allegations in New York state courts and related federal or regulatory investigations. These cases often turn on intent, records, billing history, statements, agency contact, dollar thresholds, and whether the government can prove a fraud rather than a mistake, dispute, or compliance issue.
What Prosecutors Must Prove
Using the New York statutory framework and the Criminal Jury Instructions approach, prosecutors must be able to prove each required element beyond a reasonable doubt. For New York Penal Law 177.25, the proof usually focuses on the following:
- that the accused acted with intent to defraud a health plan;
- that the accused knowingly and willfully provided materially false information or omitted material information;
- that the information or omission was used to request payment for a health care item or service;
- that a payment was received that the recipient was not entitled to under the circumstances; and
- that the wrongfully received payment from a single health plan within the statutory period exceeded $1,000,000.
The proof is not just whether an insurer, health plan, investigator, or agency thinks something looks suspicious. The government must prove the charged mental state, the material falsehood or omission, the connection to payment or benefits, and the statutory dollar threshold where the degree requires one.
How This Charge Can Come Up
First-degree health-care fraud is a major felony allegation that may involve large-scale provider investigations, alleged billing patterns, data summaries, search warrants, subpoenas, interviews, and possible overlap with federal health-care fraud theories.
Fraud cases frequently begin before an arrest. A person may first receive a call from an investigator, a subpoena, an insurance SIU inquiry, an audit request, a letter from a government agency, an employer inquiry, or a request for documents. Early defense involvement can help control statements, preserve helpful records, and prevent a civil or administrative issue from becoming worse.
Defense Issues in Health Care Fraud Cases
- The million-dollar threshold is not proven claim by claim.
- The case depends on statistical assumptions or flawed audits.
- Legitimate treatment, billing, or supervision facts are being overlooked.
- There are weaknesses in intent, materiality, and health-plan entitlement proof.
- Early defense work may reduce criminal exposure and protect licensing, assets, and business operations.
Depending on the case, the defense may also involve forensic accounting, expert review of billing or claim practices, suppression motions, subpoena challenges, witness investigation, restitution negotiations, licensing strategy, immigration analysis, and careful handling of any parallel federal inquiry.
Sentencing, Restitution, and Collateral Consequences
Health Care Fraud in the First Degree Lawyer is charged as a Class B felony. Beyond the statutory criminal exposure, these cases can involve restitution, civil recovery, asset restraint or forfeiture, exclusion from programs, professional discipline, employment consequences, immigration issues, and long-term reputational harm.
For professionals and business owners, the goal is not only to address the courtroom case. The defense should also consider licenses, credentialing, employment records, public reputation, search results, and whether the case can be narrowed or resolved before it causes wider damage.
Why Contact Lebedin Kofman LLP
Russ Kofman and Lebedin Kofman LLP handle serious criminal matters, fraud investigations, federal cases, asset issues, DWI cases, Title IX matters, and high-stakes allegations where employment, licensing, and reputation are on the line. The firm works to identify proof problems early, challenge overbroad allegations, and position cases for dismissal, reduction, trial, or strategic resolution.
Visitors should be able to see that the firm has handled serious, sensitive, and high-exposure cases. Review the firm’s client feedback, representative matters, and Russ Kofman’s profile before deciding who to call.
Related Fraud and Document Crime Pages
Frequently Asked Questions
Should I speak to investigators or auditors?
Speak with defense counsel first. Statements to insurers, health plans, agencies, employers, auditors, or police can be used later and may affect whether the case grows.
Can a billing mistake become a criminal case?
It can, but a mistake is not the same thing as criminal intent. Many defenses focus on whether the disputed record was knowingly false, material, and submitted with intent to defraud.
Can these cases become federal?
Yes. Insurance, health-care, billing, mail, wire, tax, bank, and benefit-fraud investigations can overlap with federal jurisdiction. The federal-defense strategy should be considered early.
Contact
If you are under investigation, received a subpoena, were contacted by an insurer or health plan, or were arrested for health care fraud, early legal representation can affect the direction of the case.
Source basis: NY Senate Penal Law 177.05 and 177.25; NY Courts CJI Article 177 framework. Prior results do not guarantee a similar outcome. Every case is unique and must be evaluated on its own facts and circumstances.
Why People Call Lebedin Kofman LLP
When a criminal allegation, DWI arrest, federal investigation, Title IX matter, or high-stakes accusation can affect your freedom, license, job, education, immigration status, or reputation, you should be able to speak with a defense lawyer quickly and get a clear plan.
- Speak with a lawyer about an arrest, investigation, court date, order of protection, license consequence, or federal exposure.
- Get early guidance before speaking with police, prosecutors, school investigators, insurers, agencies, or employers.
- Review defense options including dismissal, reduction, suppression issues, trial posture, negotiation strategy, and collateral consequences.
Health Care Fraud in the First Degree: What Prosecutors Must Prove
NY Penal Law 177.25 - source framework: New York Criminal Jury Instructions for Health Care Fraud 1-4.
- The prosecution generally must prove that the accused, with intent to defraud a health plan, knowingly and willfully provided materially false information or omitted material information.
- The People must prove the information or omission was used to request payment from a health plan for a health care item or service, and that payment was received in an amount not entitled under the circumstances.
- Defense review should test intent, materiality, billing rules, medical necessity, coding, provider records, Medicaid or insurer rules, aggregation, payment amount, expert proof, audits, electronic health records, search issues, statements, and whether the alleged conduct is civil or administrative rather than criminal.
First-degree health care fraud generally involves alleged wrongfully received health-plan payments exceeding ,000,000 within the statutory aggregation period, creating extreme felony exposure.
Health-care-fraud cases often involve Medicaid or private-plan rules, audits, medical records, billing codes, expert review, licensing consequences, restitution, immigration concerns, and reputation damage. The firm handles serious fraud and criminal-defense matters and offers a free attorney consultation. Call 646-663-4430 so an attorney can quickly evaluate exposure and defense strategy.