New York City Medicare Fraud Lawyer

Federal health care fraud investigations move quietly at first. The government builds its case over months or years before a single target knows they are in the crosshairs. By the time agents arrive at a medical office, billing department, or clinic with a warrant, the investigation is already far along. For physicians, pharmacists, hospital administrators, billing companies, and health care executives in New York City, a New York City Medicare fraud lawyer is not a contingency plan. It is the most critical decision in the entire arc of a federal prosecution.

Medicare fraud cases are prosecuted by the Department of Justice and the Department of Health and Human Services Office of Inspector General, often in coordination with the FBI and the U.S. Attorney’s Office for the Southern or Eastern Districts of New York. These are sophisticated, well-funded prosecutions built around financial records, billing data, cooperating witnesses, and undercover operations. The gap between a civil audit and a criminal indictment can close faster than most providers expect.

The Law Offices of Jason Goldman represents individuals and entities who are under federal investigation or have been indicted on Medicare and health care fraud charges. Whether a provider is still in the pre-arrest investigation phase or already navigating the federal courts in Manhattan or Brooklyn, this firm brings the kind of strategic, front-to-back representation that these cases demand.

What Medicare Fraud Charges Actually Look Like in Federal Court

Federal prosecutors in New York have handled some of the largest health care fraud prosecutions in the country. The Southern District of New York and the Eastern District of New York are both aggressive venues for these cases, and the charges that arise from them carry consequences that extend well beyond the courtroom. Criminal conviction in a Medicare fraud case typically results in exclusion from all federal health care programs, professional license revocation, and substantial prison terms under federal sentencing guidelines that take the amount of the alleged fraud loss as a primary driver of punishment.

The offenses charged in these cases fall under the federal health care fraud statute and the Anti-Kickback Statute, among others. Prosecutors also routinely layer on wire fraud, conspiracy charges, and money laundering to increase exposure and complicate the defense. The breadth of those charging decisions is itself a pressure tactic designed to push defendants toward cooperation or guilty pleas. Understanding how and why those charges are assembled is the starting point of any serious defense.

Common Medicare Fraud Allegations That Lead to Federal Prosecution

• Billing for Services Not Rendered: Federal investigators analyze claims data for patterns of billing on dates when a provider could not have seen the volume of patients billed, including billing for deceased patients or individuals who were never treated at the facility.
• Upcoding and Unbundling: Systematically billing at higher reimbursement codes than the service provided justifies, or separating bundled services into individual line items to collect more than Medicare allows, is treated as intentional fraud rather than billing error when patterns emerge across thousands of claims.
• Kickback Arrangements: Payments, referral fees, or anything of value exchanged for Medicare patient referrals violates the Anti-Kickback Statute. These arrangements are common targets in investigations involving home health agencies, durable medical equipment suppliers, and specialty clinics.
• Phantom Prescriptions and DME Fraud: Fraudulent prescriptions for durable medical equipment, power wheelchairs, or orthotics that patients never received or did not medically need have been the center of major prosecutions originating in the New York metropolitan area.
• Home Health Fraud: Billing for homebound care that was never provided, or certifying patients as homebound when they were not, has drawn sustained enforcement attention in the boroughs of New York City and Long Island communities with large elderly populations.
• Compounding Pharmacy Fraud: Prescriptions steered to compounding pharmacies in exchange for kickbacks, and claims submitted for compounded medications that were medically unnecessary or never dispensed, have generated both criminal and civil False Claims Act exposure.
• Identity Theft and Credential Abuse: Using another provider’s billing number without authorization, or submitting claims under a physician’s credentials without their knowledge, creates exposure for both the bad actor and, in some circumstances, the credentialed provider.

Why the Pre-Arrest Stage Is the Most Important Window

Jason Goldman built his practice on pre-arrest investigations, and that discipline is particularly consequential in federal health care fraud cases. Federal agents investigating Medicare fraud often spend years developing their case before any arrest is made. During that time, they are conducting interviews, issuing subpoenas for billing records, reviewing CMS claims data, and often running cooperating witnesses into clinics or billing offices.

A provider who receives a subpoena for records, a visit from HHS-OIG agents, or a letter from a Medicare contractor initiating a prepayment or post-payment audit should treat that contact as the beginning of a criminal investigation, not an administrative matter. The decisions made in the first days and weeks after that contact, what to say, what to produce, whether to cooperate, and how to respond publicly, shape the entire case that follows.

Mr. Goldman’s approach at the pre-arrest stage centers on conducting a parallel investigation. That means pulling the same data the government is likely reviewing, understanding where the exposure actually lies, identifying potential cooperating witnesses before they are flipped, and positioning the client to minimize criminal exposure through proactive engagement with the government where that strategy makes sense. In some cases, the right pre-arrest move prevents an indictment entirely. That outcome is only available when a defense attorney is in the room before charges are filed.

Building a Defense in a Federal Medicare Fraud Case

The government’s primary tool in Medicare fraud prosecutions is data. Prosecutors will present charts and summaries of claims data designed to make billing anomalies look like unmistakable proof of intent to defraud. A competent Medicare fraud attorney in New York understands that every data point has context, and that context is the defense.

Patient complexity, supervising physician oversight, billing staff errors, software misconfiguration, coding guidance from third-party consultants, and ambiguous Medicare coverage rules are all legitimate explanations that must be investigated and, where supported, presented. The difference between a pattern of fraud and a pattern of coding error comes down to intent, and intent is genuinely disputed in a significant number of these cases.

Expert witnesses play a central role in federal health care fraud defense. Medical necessity experts, coding and billing specialists, and forensic accountants can directly contest the government’s characterization of the claim data. Mr. Goldman’s practice involves building that expert infrastructure early, not as an afterthought once the trial date is set. A health care fraud defense attorney in New York must also be prepared to litigate the loss amount aggressively, because federal sentencing guidelines tie prison exposure directly to the dollar figure the government attributes to the fraud. Contesting that number through expert analysis and evidentiary challenges is one of the highest-leverage moves in the sentencing phase.

False Claims Act civil exposure often runs alongside the criminal case. The government or a relator (a whistleblower) may file a civil FCA action that operates independently of the criminal prosecution. Managing both simultaneously requires coordination between the criminal defense strategy and any civil response, since statements and positions taken in one proceeding can affect the other.

What Jason Goldman Brings to a Federal Health Care Fraud Defense

Jason Goldman began his career as a Brooklyn prosecutor, where he tried serious felony cases and developed a firsthand understanding of how government investigations are built and where they can be taken apart. That prosecutorial perspective informs every phase of his defense work. He knows what federal agents are looking for, what weaknesses in a case the government will try to paper over, and what arguments land with federal juries in New York.

Having tried more than 25 cases to verdict, Mr. Goldman is a trial lawyer in the truest sense. Federal prosecutors know who in the defense bar will take a case to trial and who will not. That distinction matters in plea negotiations, in motion practice, and in how seriously the government treats challenges to its case. The New York Post has called Mr. Goldman “high-powered,” and WABC’s Sid Rosenberg described him as “brilliant.” These are not marketing constructs. They reflect a track record built case by case in courtrooms across New York.

Mr. Goldman is admitted to practice in the Southern and Eastern Districts of New York, the two federal venues where Medicare fraud cases in New York City are prosecuted. His firm has represented corporate executives in finance, real estate, and healthcare, alongside physicians, administrators, and other professionals navigating federal criminal exposure. He is a member of the National Association of Criminal Defense Lawyers and the New York State Association of Criminal Defense Lawyers, organizations that keep practitioners current on federal enforcement trends. When a case attracts media attention, Mr. Goldman has the network and the experience to manage public perception strategically, an asset that matters in high-profile health care fraud prosecutions where professional reputation is inseparable from the legal outcome.

If You Receive an OIG Subpoena, an FBI Visit, or a Medicare Audit Notice

Anyone in the New York area who receives contact from the HHS Office of Inspector General, the FBI, the U.S. Attorney’s Office, or a Medicare Administrative Contractor should retain counsel before responding to anything. Do not speak to investigators without an attorney present. Do not produce documents in response to a subpoena without having an attorney review the scope of the demand and assess whether any privilege objections apply. Do not assume that cooperation without counsel will be viewed favorably. Federal agents investigating fraud are gathering evidence, not offering protection.

Federal Medicare fraud cases in New York are prosecuted in the Southern District of New York, located at 500 Pearl Street in Manhattan, and the Eastern District of New York at 271 Cadman Plaza East in Brooklyn. Grand jury proceedings, indictments, arraignments, and trials all flow through those courthouses. Understanding how cases move through each district, including the individual practices of judges and the tendencies of particular AUSA units, is knowledge that comes from working in those courthouses regularly.

On the civil side, False Claims Act suits are filed in the same federal courts. CMS administrative exclusion proceedings are handled separately through the HHS Departmental Appeals Board. Providers who receive a notice of proposed exclusion have a narrow window to request a hearing, and missing that deadline eliminates appeal rights at the administrative level. Time limits in federal health care matters are real and unforgiving. Acting immediately when any of these contacts occur is not overcaution. It is the minimum appropriate response.

Questions Providers and Executives Ask About Medicare Fraud Defense

What is the difference between a Medicare audit and a criminal investigation?

A Medicare audit initiated by a contractor, such as a Recovery Audit Contractor or a Unified Program Integrity Contractor, is technically a civil administrative process aimed at identifying overpayments. However, audit findings are routinely shared with the HHS-OIG and DOJ, and patterns identified in an audit can trigger or accelerate a criminal investigation. The civil and criminal processes run on parallel tracks, and a provider facing an audit should not assume the matter will remain administrative.

Can a Medicare fraud conviction result in prison time?

Yes. Federal health care fraud carries significant prison exposure under federal sentencing guidelines, and the guidelines calculate the base offense level largely based on the intended or actual loss amount. Large Medicare fraud cases routinely result in sentences measured in years, not months. The fraud loss calculation is one of the most aggressively contested issues in the sentencing phase of these cases.

What is the Anti-Kickback Statute and how does it apply to physicians?

The Anti-Kickback Statute prohibits offering, paying, soliciting, or receiving anything of value in exchange for referrals of items or services covered by federal health care programs, including Medicare. For physicians, this means that certain arrangements with hospitals, device companies, labs, or other providers that involve any form of compensation tied to referrals can trigger liability. There are statutory safe harbors that protect certain arrangements, but those safe harbors have specific requirements that must be met precisely.

Is it possible to face Medicare fraud charges even if I did not personally submit the fraudulent claims?

Yes. Federal prosecutors regularly charge practice owners, medical directors, and administrators under conspiracy theories even when the underlying billing was handled by staff or a third-party billing company. If the government can show that a defendant knew of the fraudulent scheme and took any act in furtherance of it, direct submission of the claims is not required for criminal liability.

What happens to my medical license if I am indicted for Medicare fraud?

A federal indictment for Medicare fraud can trigger action by the New York State Department of Education, which oversees professional licensing for physicians, nurses, pharmacists, and other licensed health care providers. The licensing board can initiate proceedings to suspend or revoke a license while a criminal case is pending, before any conviction. Managing the licensing exposure alongside the criminal defense is a critical coordination challenge that requires attention from the outset of representation.

Can I be excluded from Medicare even if I am acquitted?

Yes. The HHS-OIG’s authority to exclude providers from Medicare and other federal health care programs operates independently of the criminal justice system. An exclusion can be imposed based on administrative findings, civil settlements, or certain triggering events that do not require a criminal conviction. Mandatory exclusion applies to convictions under specific statutes. Permissive exclusion can be applied across a broader range of circumstances, including a pattern of fraudulent claims even absent conviction.

What is a Civil Investigative Demand, and what should I do if I receive one?

A Civil Investigative Demand is a formal document issued by the DOJ in connection with a False Claims Act investigation. It functions similarly to a subpoena and can require the production of documents, written answers to interrogatories, or oral testimony. Receiving a CID means the government is actively investigating potential false claims liability. Retaining counsel immediately and before making any response or production is essential, as the scope of the demand and the manner of compliance can significantly affect subsequent proceedings.

How long do federal Medicare fraud investigations typically run before charges are filed?

Federal Medicare fraud investigations often span two to four years or longer before an indictment is returned. The government uses that time to build a comprehensive evidentiary record, recruit cooperating witnesses, and conduct surveillance. Targets frequently have no formal notice during this period, though they may receive audit notices, contractor correspondence, or see unusual claim rejections that signal scrutiny. The length of these investigations underscores why pre-arrest representation matters so much.

Can a health care business entity face Medicare fraud charges, or only individuals?

Both. Corporate entities, including medical practices, billing companies, home health agencies, and DME suppliers, can be charged as defendants in federal health care fraud prosecutions. Individual owners, officers, and key employees can also be charged alongside the entity. When entities are charged, the consequences include criminal fines, forfeiture of proceeds, and mandatory exclusion from federal health care programs, which in practice can shut down an operating business entirely.

How does forfeiture work in a Medicare fraud case?

Federal prosecutors pursue forfeiture aggressively in health care fraud cases, seeking to recover proceeds traceable to the fraud. This can include funds in business accounts, personal bank accounts, real estate purchased with fraud proceeds, and other assets. The government can seek a restraining order to freeze assets even before trial, which can affect a defendant’s ability to fund their own defense. Challenging forfeiture demands, including the tracing methodology and the asset valuations the government uses, is a distinct and important component of the overall defense strategy.

Medicare Fraud Defense Across New York City and the Surrounding Region

The Law Offices of Jason Goldman represents clients facing Medicare and federal health care fraud investigations and charges across the full New York metropolitan area. In New York City, this includes providers and executives in Manhattan, from Midtown health care corridors through the Upper East Side medical community and down to Lower Manhattan financial and administrative offices. The firm serves clients across all five boroughs, including Brooklyn, where the Eastern District of New York courthouse handles a significant portion of federal Medicare fraud prosecutions originating in Kings County, Queens, and Staten Island, as well as the Bronx, where home health and community health center fraud cases arise regularly.

Beyond the city itself, the firm extends its federal criminal defense representation to Long Island, including Nassau County and Suffolk County communities where large populations of Medicare-eligible patients have made the region a recurring focus of federal enforcement. Clients in Westchester County, Rockland County, and the broader Hudson Valley also turn to the firm when facing federal health care fraud exposure rooted in investigations emanating from SDNY jurisdiction. New Jersey providers who find their cases pulled into New York federal courts, as happens in multi-district investigations, are also within the firm’s scope of representation, with Mr. Goldman admitted to practice in New Jersey as well.

Speak With a New York City Medicare Fraud Attorney Before the Government Speaks to You

Federal prosecutors in New York are experienced, well-resourced, and methodical. By the time a provider learns they are a target, the investigation has almost always been underway for a significant period. Working with a New York City Medicare fraud attorney who understands how these cases are built, and how they can be defended or resolved, is the clearest path to protecting both freedom and professional standing. The Law Offices of Jason Goldman handles Medicare fraud defense at every stage, from the first subpoena through trial and appeal, and that full-spectrum capability is exactly what these prosecutions require. Contact the firm today to discuss the specifics of your situation and what can be done about it.