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What a NYC Healthcare Fraud Lawyer Does When Federal Investigators Target You
A fraud allegation tied to Medicare, Medicaid, or a private health plan can threaten your medical license, your income, and your freedom at the same time. Doctors, dentists, pharmacists, billing managers, and health care business owners across New York face this risk every year, often after a routine audit turns into something much larger.
A NYC healthcare fraud lawyer at the Law Offices of Robert Tsigler, PLLC can help you understand what federal investigators are looking at and what happens next. Firm founder Robert Tsigler is admitted to the U.S. District Courts for the Eastern and Southern Districts of New York, where federal health care fraud cases are filed.
He interned at the Kings County District Attorney’s Office before founding the firm. That background gives him a well-rounded perspective on a case, whether it stays in state court or moves into federal court. Reach out to talk through what a subpoena, audit letter, or arrest means for your specific situation.
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Federal Health Care Fraud Charges Under 18 U.S.C. Section 1347
Most federal health care fraud cases are charged under Title 18 of the U.S. Code, Section 1347. It applies whenever someone knowingly and willfully executes or attempts a scheme to defraud Medicare, Medicaid, or a private health plan. Federal law treats an attempted scheme the same as a completed one.
A conviction carries up to 10 years in prison. That rises to 20 years if the scheme causes serious injury and up to life if it results in a patient’s death, plus fines and mandatory restitution. Prosecutors can also add a conspiracy charge under Section 1349, which carries the same maximum penalty.
The Anti-Kickback Statute: Payments for Referrals
The federal Anti-Kickback Statute makes it a felony to knowingly and willfully offer, pay, solicit, or receive anything of value to induce or reward referrals for services that a federal health care program pays for. A conviction can bring up to 10 years in prison and a fine of up to $100,000.
Prosecutors do not have to prove that a bill was false. The payment itself is the alleged crime. These cases often involve consulting fees, rent, marketing arrangements, or referral bonuses tied to Medicare or Medicaid patients. Not every arrangement that involves money is illegal, and the government still has to prove intent.
The False Claims Act: Civil Liability and Whistleblower Suits
The False Claims Act is a civil law, so the Department of Justice can use it with or without a criminal charge. A provider can be liable for knowingly submitting a false claim, which includes acting with deliberate ignorance or reckless disregard. The law does not require proof of intent to defraud.
Damages can reach three times the government’s loss, plus a civil penalty for each false claim. A claim that results from an Anti-Kickback violation also counts as a false claim under this law.
The False Claims Act also lets a current or former employee file a whistleblower suit on the government’s behalf and share in any recovery. These suits are filed under seal, so many providers first learn about one when the Department of Justice sends a subpoena or a civil investigative demand for records.
Strike Force Cases: How Federal Prosecutors Build These Cases
The Department of Justice runs a Health Care Fraud Strike Force program that has operated since March 2007. Before its 2026 nationwide takedown, it had charged more than 6,200 defendants who billed federal health care programs and private insurers more than $45 billion.
On June 23, 2026, the Department announced charges against 455 defendants in a $6.5 billion enforcement action, including 90 doctors and other licensed medical professionals. In the Eastern District of New York, eight defendants were charged in an alleged $38 million fraud on New York Medicaid involving social adult day care services and kickbacks. Some of the day care centers involved had a permitted occupancy of 30 people but allegedly billed for hundreds of beneficiaries a day. These charges are allegations.
The Department says the takedown relied on data analytics to identify its targets. It was led by the Department’s Health Care Fraud Unit, with partners that included the HHS Office of Inspector General, the FBI, and state Medicaid Fraud Control Units.
In July 2026, federal regulators denied recertification to New York’s own Medicaid Fraud Control Unit and suspended its funding. In response, the U.S. Attorney’s Office for the Northern District of New York said it was expanding its own federal health care fraud enforcement in its district.
Losing Your License or Your Right to Bill Federal Programs
A criminal charge is rarely the only consequence. A conviction, and sometimes just a complaint, can trigger a separate licensing referral to the New York State Office of Professional Medical Conduct or the equivalent board for your profession. That referral puts your ability to practice at risk independent of any prison sentence.
The Department of Health and Human Services Office of Inspector General can also exclude you from every federal health care program, not just Medicaid. Exclusion is mandatory for at least five years after a conviction for a program-related crime or a felony health care fraud offense. Even a misdemeanor conviction relating to health care fraud can lead to a discretionary exclusion.
These administrative actions can move on a separate track from the criminal case, and sometimes faster. Responding to an audit letter or exclusion notice without legal guidance can make these consequences harder to undo later.
Legal Defenses a NYC Healthcare Fraud Lawyer Can Raise
Defenses depend on which law the government uses. Section 1347 and the Anti-Kickback Statute both require proof that you acted knowingly and willfully. A billing mistake or a coding error is not enough. If the evidence shows negligence rather than a deliberate scheme, that is a real defense to the charge.
In a kickback case, a lawyer can look at whether the arrangement fits within the law’s exceptions and safe harbors and whether the government can prove what you intended. In a False Claims Act case, the focus shifts to whether the claims were actually false and whether the government can show the knowledge the statute requires.
A staff member who acted at a supervisor’s direction, without personally profiting from the scheme, may also be able to show they lacked intent to defraud. A NYC healthcare fraud lawyer can examine the billing records and communications to see which of these arguments fits the facts.
How Our Attorneys Approach Your Defense
Robert Tsigler holds a 10.0 “Superb” rating on Avvo.
He has also been selected to the Super Lawyers Rising Stars list. He is admitted in New York, New Jersey, before the Board of Immigration Appeals, and before federal courts including the Second and Sixth Circuit Courts of Appeals.
Attorney Joseph Caldarera previously worked as a Brooklyn assistant district attorney, giving the team a former prosecutor’s perspective. The firm also uses an internal roundtable approach, where multiple attorneys weigh in on strategy for complex cases.
Health care fraud cases often involve billing records, several federal and state laws, and both civil and criminal exposure. Our team’s courtroom admissions, prosecutor’s perspective, and shared approach to strategy help us look at your case from every angle.
Clients can reach the firm 24 hours a day, which matters when a subpoena or search warrant shows up without warning. This information reflects New York and federal law as of October 2026.
Where Federal Health Care Fraud Cases Are Prosecuted in New York
Where your case lands depends on where the alleged conduct happened and which agency picks it up first. Federal cases from Brooklyn, Queens, Staten Island, or a Nassau or Suffolk County practice near our Garden City office generally fall under the Eastern District of New York. A Manhattan or Bronx case typically falls under the Southern District of New York.
Civil and administrative matters often run on a separate track altogether. State prosecutors and the Office of the Medicaid Inspector General handle their own cases, which turn on different rules.
With offices in Manhattan, Brooklyn, Queens, and Garden City, our team works with clients across these overlapping jurisdictions.
State Charges and Medicaid-Specific Rules
New York prosecutes health care fraud separately under Article 177 of the Penal Law, which sets five degrees of the offense based on the dollar amount paid. Medicaid audits, state exclusions, and the Attorney General’s Medicaid Fraud Control Unit follow their own process. Our NYC Medicaid fraud page covers those state rules in detail.
Frequently Asked Questions
Can I face federal charges even if I never submitted a false bill?
Yes. The Anti-Kickback Statute targets payments for referrals, so the payment itself can be charged. A claim that results from a kickback can also create False Claims Act liability. A NYC healthcare fraud lawyer can review the arrangement to see which laws the government may rely on.
What is the difference between a criminal case and a False Claims Act case?
A criminal case can end in prison, and the government must prove its charges beyond a reasonable doubt. A False Claims Act case is civil and seeks money damages and penalties. The two can run at the same time, and the False Claims Act does not require proof of intent to defraud.
What if a former employee filed a whistleblower suit against my practice?
Whistleblower suits are filed under seal, so you may not know about one until the Department of Justice contacts you. A subpoena or civil investigative demand can be the first sign. A lawyer can respond to that request for you and work to protect your position while the government decides whether to take over the case.
Will I be excluded from Medicare and Medicaid if I am convicted?
Often, yes. The Office of Inspector General must exclude you from all federal health care programs for at least five years after a conviction for a program-related crime or a felony health care fraud offense. Other convictions can lead to a discretionary exclusion.
If my practice is in Queens or Nassau County, could my case end up in federal court in Brooklyn?
Yes. Queens County and Nassau County both fall within the Eastern District of New York, whose main federal courthouse sits in Brooklyn. A case that starts as a local audit can be referred to federal prosecutors there instead of staying with the local district attorney.
What should I do if I receive a subpoena, an audit letter, or a visit from agents?
It is usually best to speak with a lawyer before you respond, submit documents, or answer questions. Statements made to an auditor or investigator, even ones meant to clear things up, can become evidence later. A NYC healthcare fraud lawyer can handle the response for you.
Does the Law Offices of Robert Tsigler offer a consultation for health care fraud cases?
The firm offers an initial consultation to potential clients, and financing is available to help with legal fees for those facing these charges. Given the stakes in a health care fraud case, an early conversation about your specific situation is worth having.
Why You Need a NYC Healthcare Fraud Lawyer Before You Respond
Health care fraud cases can move fast once an agency decides to act, and the gap between a civil audit and a criminal charge can close quickly. Whether your matter is still at the subpoena stage or has already turned into an arrest, a NYC healthcare fraud lawyer can start working on your defense immediately.
That includes cases that move between state and federal court. Contact us today to talk through your situation before you respond to investigators on your own.
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