New York Healthcare Fraud Lawyer

Trusted New York Healthcare Fraud Attorney

Healthcare providers or facilities can face fraud accusations and investigations for several issues, including improper billing practices, referral anti-kickback violations, and governmental benefits fraud. These cases can have serious civil and administrative consequences for your business and practice, and could even have criminal consequences. You need a New York healthcare fraud lawyer to advocate for your rights and work against an investigation or audit.

A New York Healthcare Lawyer You Can Rely on at Weiss Zarett Brofman Sonnenklar & Levy, P.C.

At Weiss Zarett Brofman Sonnenklar & Levy, P.C., our seasoned attorneys have years of experience and know how to navigate healthcare fraud cases. We have experience in judicial district courts throughout New York, like the 10th Judicial District Courts in Suffolk and Nassau, and can represent you if the case proceeds to court. Even before court, our attorneys can help you protect your rights and potentially avoid court entirely.

We help you navigate audits, investigations, and other reviews to assess fraud. These cases can impact your business and your reputation, so quick and effective legal actions are crucial.

Our firm started as a small firm that has grown over the years, but we have never lost sight of the importance of focusing on our clients. We work closely with you to understand your unique situation and provide you with the legal support you deserve. You are not passed off to an inexperienced employee at this firm, but always work directly with experienced members of our team personally.

Types of Healthcare Fraud Cases in New York

A healthcare business and its providers are subject to business law, healthcare law, employment law, workplace safety law, and much more. This makes compliance with all of these regulations very difficult, but it is essential that businesses and professionals are compliant.

Fraud is one form of non-compliance that can occur in any of these areas of law. Healthcare fraud usually requires intent, but it may not always. There can be severe consequences to your license, your business, and your future if you are convicted of fraud offenses.

Three hundred and forty healthcare fraud cases were reported to the U.S. Sentencing Commission in fiscal year 2025. There were 805 adverse actions taken against medical practitioners in 2025 in New York, 656 of which were licensure or certification actions. At our firm, we can help with many types of healthcare fraud cases, including:

Medicare and Medicaid Fraud

Medicare and Medicaid civil fraud can be pursued even if you did not intend to commit fraud. This form of fraud is addressed by the civil and criminal False Claims Act (FCA).

Common forms of Medicare and Medicaid fraud include:

• Submitting claims for services not completed to get reimbursement
• Billing the programs for a higher amount than the value of services provided, or upcoding
• Submitting a claim you know is false or fraudulent and other forms of Medicaid and Medicare fraud

Civil recoveries for Medicaid fraud in fiscal year 2025 were about $706 million from 674 civil settlements and judgments reported by the State Medicaid Fraud Control Units (MFCU). Violations of the FCA are very serious.

Anti-Kickback Statute Violations

The Anti-Kickback Statute prevents medical providers from providing any form of reward for referring a patient to specific medical supplies, services, or medication, when the provider is reimbursed by federal healthcare benefits programs for those services. Like Medicare and Medicaid fraud, this offense does not require knowledge to be civilly charged, but willingly committing the violation makes it a criminal offense.

Billing Fraud

Billing fraud includes:

• Charging for services not completed
• Recommending or prescribing services that are not medically necessary
• Submitting multiple claims for a single service
• Upcoding, or overcharging on services rendered
• Billing deceased patients

Billing fraud can affect patients and private healthcare companies.

Prescription Drug Fraud

Prescription medication and drug fraud includes:

• Diverting legal substances for illegal use
• Forging prescriptions
• Overprescribing
• Prescribing not medically necessary substances
• Distributing a controlled substance outside of a practice

FAQs

What Is the Penalty for Insurance Fraud in New York?

Insurance fraud in New York can be charged as a Class E, D, C, or B felony, which means penalties can range from up to four years to up to 25 years of imprisonment and up to $5,000 to up to $30,000 in fines. These offenses can also be charged federally. Insurance fraud can also lead to a practice being shut down and the loss of a professional license.

What Qualifies as Healthcare Fraud?

There are many types of fraud that qualify as healthcare fraud, including Medicare and Medicaid fraud, other False Claims Act violations, advertising regulation violations, and billing fraud and unbundling.

Healthcare fraud also includes self-referrals, other Stark Law violations, Anti-Kickback Statute violations, prescription drug fraud, and HIPAA or HITECH violations. It can also include identity theft or mail and wire fraud committed in a healthcare setting. Violating these and other healthcare laws can lead to serious administrative, civil, and criminal penalties.

How Much Does a Lawyer Cost for a Fraud Case?

The cost of a lawyer for a fraud case defense depends on the attorney, your location, and your specific case. A more complex case with more serious civil consequences or criminal charges is likely to be more costly. Rates may be higher for these cases, and they often take longer to resolve, which increases the total cost of an hourly rate.

At Weiss Zarett Brofman Sonnenklar & Levy, P.C., we strive for reasonable rates.

Why Do You Need to Hire a Healthcare Fraud Lawyer in New York?

You need to hire a healthcare fraud lawyer in New York to protect your interests, your career, and your practice. If you are being investigated or audited for fraud offenses, it’s important to work with an attorney as soon as possible. Preemptive legal support may even be able to avoid criminal charges entirely. An attorney can help you understand your situation and legal options. You are more likely to reach a favorable outcome with the right attorney by your side.

New York Healthcare Fraud Attorney

At Weiss Zarett Brofman Sonnenklar & Levy, P.C., we can help you navigate healthcare fraud laws and protect your career and your practice. You don’t have to navigate it alone. Contact our firm today and get a qualified legal advocate in your corner.