New York City Healthcare, Medicaid, and Insurance Fraud Lawyer

Federal and state investigators have made healthcare fraud a top enforcement priority, and the consequences of a conviction extend far beyond fines and prison time. Careers built over decades can collapse in an instant. Medical licenses get revoked. Billing relationships with government programs get permanently severed. And unlike many white-collar prosecutions, healthcare fraud cases often target not just the institution but the individual clinician, administrator, or executive who signed off on the paperwork. New York City healthcare, Medicaid, and insurance fraud prosecutions are among the most technically complex and aggressively litigated cases in the federal system, and the people caught in them frequently do not realize the full scope of the investigation until it is already well advanced.

What makes these cases particularly dangerous is the volume of conduct that can be characterized as fraud. A billing code entered incorrectly over hundreds of claim submissions becomes, in a prosecutor’s hands, a pattern. A referral arrangement that seemed routine gets reframed as a kickback scheme. Upcoding, unbundling, billing for services not rendered, false diagnoses, phantom patients, forged prescriptions, and unnecessary procedures are all theories prosecutors use to build criminal cases. The government has sophisticated data analytics tools capable of flagging statistical anomalies in billing records, which means investigations often begin long before the target knows they are being watched.

Jason Goldman represents individuals and entities facing this kind of exposure. His practice covers the full arc from pre-arrest investigations, when intervention can still shape the outcome, through trial and appeal. His background as a Brooklyn prosecutor gives him a clear picture of how these cases are built from the government’s side, and he uses that understanding to find the weaknesses that matter.

What a Healthcare Fraud Case Actually Looks Like Before Charges Are Filed

Healthcare fraud investigations routinely run for years before a single arrest is made. Federal agencies including the Department of Justice, the Office of Inspector General for the Department of Health and Human Services, the FBI, and the Department of Homeland Security Investigations often work in parallel. In New York, the Medicaid Fraud Control Unit, which operates out of the New York State Attorney General’s office, conducts parallel state-level investigations that can result in separate charges under state law.

The early warning signs are real and recognizable. A civil investigative demand or subpoena for billing records. A surprise inspection from federal agents. An employee who is quietly approached by investigators. A request from a payer for a routine audit that turns adversarial. Any one of these signals warrants immediate attention from a healthcare fraud attorney in New York. Waiting to see how things develop is one of the most common and costly mistakes a potential target can make.

Pre-arrest intervention is a core part of Jason Goldman’s practice. When a client comes to him during the investigation phase, before any grand jury indictment or criminal complaint, the range of strategic options is significantly broader. Grand jury subpoenas can be responded to thoughtfully. Voluntary interviews can be approached strategically or declined. Document production can be handled in a way that does not inadvertently expand the government’s theory of the case. The difference between getting ahead of an investigation and reacting to an indictment is often the difference between a resolved matter and a criminal trial.

Common Charges in New York Healthcare, Medicaid, and Insurance Fraud Cases

• Federal Healthcare Fraud: Prosecutors use the federal healthcare fraud statute to charge schemes involving any healthcare benefit program, not just Medicare and Medicaid. The statute covers knowingly and willfully executing a scheme to defraud, which means intent is a central contested issue in every case.
• False Claims Act Violations: The False Claims Act targets the submission of fraudulent claims to the federal government and is often used alongside criminal charges. It also has a whistleblower component that allows employees, competitors, or former partners to initiate investigations with a financial stake in the outcome.
• Anti-Kickback Statute Violations: New York federal courts handle numerous prosecutions under this statute, which prohibits giving or receiving anything of value in exchange for referrals of patients covered by federal healthcare programs. The statute is broad, and arrangements that look like legitimate business relationships can cross the line.
• Medicaid Fraud Under New York Social Services Law: New York state maintains its own healthcare fraud statutes targeting Medicaid specifically. The Medicaid Fraud Control Unit in New York is one of the most active in the country, with investigators embedded in prosecution teams from the early stages of a case.
• Insurance Fraud: New York Penal Law covers insurance fraud involving private insurers, not just government programs. These charges frequently arise in the context of no-fault automobile insurance schemes, a major source of criminal prosecutions in the New York area involving medical providers, attorneys, and patients.
• Money Laundering: When the proceeds of a healthcare fraud scheme are funneled through accounts, reinvested in the practice, or otherwise moved, money laundering charges can attach. Federal money laundering statutes carry their own penalties and significantly expand the sentencing exposure in an already serious case.
• Conspiracy Charges: Healthcare fraud cases almost always include a conspiracy count, which allows prosecutors to hold every participant in a scheme accountable for the conduct of co-conspirators. Even a minor role in a larger billing scheme can result in exposure for the full scope of the alleged fraud.

Federal Healthcare and Medicaid Fraud Charges in New York Codified by 18 U.S.C. § 1347 , healthcare fraud has become one of the most prevalent federal offenses. Federal Insurance Fraud Charges in New York On the state level, New York prosecutors have the authority, pursuant to New York Penal Law § 176 to charge individuals with insurance fraud if they suspect that you caused materially false information to be entered into an application or claim for commercial insurance. Sentencing & Penalties in New York A healthcare fraud charge pursuant to 18 U.S.C. § 1347 carries significant penalties, typically with a maximum of 10 years’ imprisonment and a hefty fine.

If You Have Received a Subpoena or Think You Are Under Investigation

The first and most important step is to stop communicating with anyone about the underlying conduct, including employees, colleagues, and business partners, until you have spoken with a healthcare fraud defense attorney. Well-meaning conversations can create significant legal problems. Statements made to co-workers or partners can be disclosed by those individuals to investigators, and anything that looks like an attempt to coordinate stories can escalate a fraud investigation into an obstruction charge.

Preserve documents, but do not destroy anything. Healthcare fraud investigations almost always involve document review, and any destruction of records after an investigation has begun, or after you had reason to believe one might begin, constitutes obstruction. At the same time, you have no obligation to make the government’s job easier by volunteering documents beyond what is legally required.

In New York, federal healthcare fraud cases are handled by the Southern District of New York, which covers Manhattan, the Bronx, and several surrounding counties, and the Eastern District of New York, which covers Brooklyn, Queens, and Long Island. State Medicaid fraud prosecutions are typically brought by the New York Attorney General’s Medicaid Fraud Control Unit and handled in New York Supreme Court. No-fault insurance fraud prosecutions can involve the New York County District Attorney’s office, the Kings County DA, or other borough prosecutors depending on where the conduct allegedly occurred. Knowing which forum a case is in, or likely to be in, shapes every strategic decision from the start.

One of the most significant mistakes people make in these situations is agreeing to a voluntary interview with federal agents without a lawyer present. Agents are permitted to ask questions in ways that can elicit apparently inconsistent answers that later become the basis for false statements charges, even if the underlying conduct would not have resulted in a conviction. Declining to speak without counsel present is a legal right, not an admission of guilt, and it is always the right call.

Why Jason Goldman for Healthcare and Insurance Fraud Defense in New York

Healthcare fraud defense requires a lawyer who understands how federal prosecutors and investigators think, because these cases are built from the inside out. Jason Goldman began his legal career as a Brooklyn prosecutor, handling serious felony cases and learning directly how the government constructs criminal cases. That prosecutorial foundation is not a credential that sits on a resume. It informs how he reads a government investigation, anticipates its next move, and identifies the points at which an aggressive challenge can shift the outcome.

He has tried over 25 cases to verdict and has represented clients at every stage of federal and state criminal proceedings, from investigations that never result in charges to complex multi-count trials to sentencing and appeal. The New York Post has called him “high-powered,” and WABC’s Sid Rosenberg described him as “brilliant.” His firm has been cited for getting high-profile defendants results that others could not secure. He is admitted in the Southern and Eastern Districts of New York, which are the two federal courts where the overwhelming majority of New York healthcare fraud prosecutions are brought.

Beyond the courtroom, Goldman’s practice includes the kind of strategic work that rarely gets discussed publicly but frequently determines what happens to a client’s career and reputation. For clients in regulated industries, a criminal investigation can trigger immediate collateral consequences, license suspensions, exclusion from government programs, and reputational damage, long before a case is resolved. Goldman’s approach accounts for all of these fronts simultaneously. He is also deeply familiar with how media coverage shapes high-profile investigations and has the relationships and judgment to manage public attention in the client’s interest when that becomes relevant.

Questions People Ask About Healthcare Fraud Charges in New York

What is the difference between a billing error and healthcare fraud?

The legal distinction comes down to intent. An isolated billing error, made in good faith, is not a crime. Fraud requires knowing and willful conduct, meaning the person submitting the claims must have known the claims were false and done so deliberately. The problem is that when errors appear repeatedly across thousands of claims, prosecutors often argue that the pattern itself proves intent. This is why documentation of billing practices, compliance programs, and staff training can matter enormously in defending these cases.

Can I be charged even if someone else submitted the bills?

Yes. Federal healthcare fraud conspiracy charges allow the government to hold individuals accountable for the acts of others who were part of the same scheme. A physician whose credentials were used to bill for services without their direct supervision, or a practice owner who created the billing structure their staff used, can face criminal exposure even if they did not personally submit each fraudulent claim.

What are the potential penalties for a federal healthcare fraud conviction?

Federal healthcare fraud charges carry significant prison exposure, with sentences that can extend to ten years or more per count depending on the specific statute charged and the amount of loss attributed to the scheme. Money laundering and conspiracy charges layer additional exposure on top of the underlying fraud. Federal sentencing guidelines tie the recommended range closely to the dollar amount of the alleged fraud, which means cases involving large-scale Medicaid billing can result in guideline ranges well above what most defendants expect.

What happens to my medical license if I am charged with healthcare fraud?

In New York, professional licensing boards can initiate their own disciplinary proceedings based on a criminal charge, not just a conviction. The New York State Office of the Professions oversees physicians, nurses, and many other healthcare providers, and a fraud indictment often triggers an immediate referral to that office. A healthcare fraud attorney in New York can coordinate the criminal defense with the licensing defense to avoid having statements made in one proceeding used against the client in another.

What is the Medicaid Fraud Control Unit and how does it operate?

New York’s Medicaid Fraud Control Unit is a division of the State Attorney General’s office with its own investigators, prosecutors, and civil enforcement staff. It is federally certified and partially funded by the federal government, which gives it significant resources. The unit investigates both criminal fraud and civil overpayment claims, and it frequently works in coordination with federal agencies on larger cases. An investigation by the MFCU can lead to state criminal charges, civil False Claims Act liability, and referral for federal prosecution, sometimes all in the same case.

Can a healthcare fraud investigation result in exclusion from Medicare and Medicaid even without a conviction?

Yes. The Office of Inspector General for the Department of Health and Human Services has independent authority to exclude individuals and entities from participating in federal healthcare programs. In certain circumstances, exclusion is mandatory upon conviction. In others, it is discretionary and can be pursued based on conduct that did not result in a criminal conviction. For any healthcare provider, exclusion is often the most practically devastating consequence of a fraud investigation, because it ends the ability to bill government programs indefinitely.

What is no-fault insurance fraud and how does it differ from Medicaid fraud?

No-fault fraud in New York refers to schemes exploiting the state’s no-fault automobile insurance system, which requires insurers to pay medical bills up to statutory limits for people injured in car accidents regardless of who was at fault. The scheme typically involves staged accidents, fictitious injuries, or medical providers billing for treatments that were unnecessary or never provided. These cases are prosecuted under New York state insurance fraud statutes and are a major enforcement focus for DA offices throughout the boroughs, particularly in Brooklyn and Queens, where fraud rings have historically been most concentrated.

Should I cooperate with investigators if they approach me as a witness rather than a suspect?

A person’s status in a federal investigation can shift. Someone who begins as a witness can become a target if the investigation develops in a certain direction. Federal agents are not required to tell you whether you are a subject or target when they approach you, and they are permitted to use information you volunteer. Before speaking with federal investigators under any characterization, including as a witness, it is worth having a conversation with a healthcare fraud defense attorney about what you know, how it relates to the investigation, and what risks a voluntary interview creates.

How long does a federal healthcare fraud investigation typically last before charges are filed?

These investigations frequently run for two to three years before charges are brought, and in complex multi-party cases, the timeline can be longer. The federal statute of limitations for healthcare fraud is generally five years, though money laundering charges can extend that window further. The lengthy investigation timeline means that by the time a grand jury indictment is handed down, the government has typically built a substantial evidentiary record. Pre-arrest intervention during the investigation phase is often the most valuable window a defense attorney has.

What if the alleged fraud involved conduct by my employees or billing staff without my knowledge?

This is one of the most important factual defenses in healthcare fraud cases. If a practice owner or physician can demonstrate that billing staff acted outside the scope of their authority, concealed conduct from management, or exploited inadequate oversight, it can undercut the government’s proof of intent. The strength of this defense depends heavily on documentation, internal compliance procedures, and what the owner or physician knew and when. Establishing these facts early, before charges are filed, can significantly affect how the government views the case.

Healthcare Fraud Defense Representation Across New York City and the Surrounding Region

The Law Offices of Jason Goldman represents clients in healthcare, Medicaid, and insurance fraud matters throughout New York City and the broader metropolitan region. In Manhattan, the firm serves clients from Midtown and the Financial District through the Upper East Side and Washington Heights. In Brooklyn, representation extends from Downtown Brooklyn and Park Slope through Flatbush, Bensonhurst, and Bay Ridge, areas where no-fault fraud prosecutions and Medicaid billing investigations are particularly active. In Queens, the firm handles matters involving clients from Flushing, Jamaica, Astoria, Forest Hills, and the surrounding communities. The Bronx and Staten Island are equally within the firm’s reach, as are matters originating in Nassau County, Suffolk County, and Westchester County, where federal investigations originating in New York City frequently extend.

Cases brought in the Southern District of New York, the Eastern District of New York, and New York State Supreme Court across all five boroughs fall within Jason Goldman’s practice. The firm also accepts pro hac vice matters in other federal and state courts for clients whose situations require representation outside of New York.

New York City Healthcare Fraud Attorney: Contact Jason Goldman

A healthcare fraud investigation does not wait, and neither should your response to one. Whether you have received a subpoena, been approached by federal agents, learned that a colleague is cooperating with investigators, or simply noticed anomalies in a government audit, the time to get a New York City healthcare fraud attorney involved is before the situation escalates further. Jason Goldman takes on a select number of serious cases where he can provide focused, high-level representation at every stage. Reach out to the firm directly to discuss your situation in confidence.