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New York doctor accused of submitting false statements

The United States Attorney’s Office for the Western District of New York has charged a New York physician with health care fraud and submission of false claims for health care matters. The physician provided care for patients who battled opioid addiction.

The government released the charges, according to the indictment, in 2014. Essentially, the charges involve allegations of stealing an estimated $800,000 from health care benefit programs including HealthNow, Independent Health and Univera. The government has accused the physician of submission of claims for a more expensive service than provided. The physician allegedly billed for higher cost individual counseling sessions when the sessions were conducted in the less expensive group setting format. The Attorney’s Office also accused the physician of submitting claims for services provided in his clinic at a time he was not in the clinic. The government had evidence to support this claim, showing submission dates that were in line with the physician’s trip abroad.

The original charges came with a penalty of up to 10 years imprisonment and a $250,000 fine. In May of this year, the physician chose to accept a plea deal.

Why did the physician accept a plea deal? In this case, it appears the physician chose to accept a plea deal to reduce the possible penalties. Instead of the above noted decade imprisonment he now faces a maximum of one year in prison. The government would now impose a reduced monetary penalty as well, from $250,000 to $100,000.

The plea deal also resulted in a restitution payment of $550,000.

In some situations, a plea deal is a good legal strategy. In others, it is best to push forward through litigation to maintain the innocence of the accused. An attorney can review the situation and discuss the legal implications of each option.

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