Attorney for Durable Medical Equipment Fraud in New York City

Durable medical equipment (DME) fraud is one of the most aggressively investigated categories of healthcare fraud in New York City. State and federal authorities devote substantial resources to identifying suppliers, medical professionals, and business owners suspected of submitting false claims for wheelchairs, oxygen equipment, orthotic devices, hospital beds, and other medical supplies. If you or your business is under investigation or has been charged with DME fraud, the consequences can be severe—including significant prison time, crippling financial penalties, and the permanent loss of your professional licenses and Medicaid or Medicare billing privileges.

Our New York City healthcare fraud defense attorneys understand the complex statutory framework, billing regulations, and investigative tactics that govern these cases. We provide vigorous, strategic representation to individuals and companies confronting allegations of durable medical equipment fraud throughout the five boroughs.

What Is Durable Medical Equipment Fraud?

Durable medical equipment refers to medically necessary devices and supplies that are prescribed for use over an extended period. These items are typically reusable, intended for use in a patient's home, and prescribed by a licensed healthcare provider. Common examples include:

Manual and power wheelchairs and scooters
Oxygen concentrators, tanks, and related respiratory equipment
Hospital beds and pressure-relief mattresses
Orthotic and prosthetic devices, including braces and supports
Continuous positive airway pressure (CPAP) machines and supplies
Diabetic testing supplies, including glucose monitors and test strips
Walkers, canes, crutches, and other mobility aids
Nebulizers and infusion pumps

DME fraud occurs when a supplier, healthcare provider, or other party knowingly submits false or misleading claims to government programs such as Medicaid and Medicare, or to private insurers, in order to obtain reimbursement they are not entitled to receive. Because reimbursement for these items can be substantial and the volume of claims is high, even a relatively modest pattern of improper billing can quickly accumulate into allegations involving hundreds of thousands or millions of dollars.

Common Forms of DME Fraud Allegations in New York City

Prosecutors and investigators in New York pursue a wide range of conduct under the umbrella of durable medical equipment fraud. Understanding the specific theory underlying an investigation is essential to building an effective defense. Common allegations include:

Billing for Equipment Not Provided

This is among the most frequently charged forms of DME fraud. Authorities allege that a supplier submitted claims for equipment that was never delivered to the patient, or that was returned and never replaced.

Upcoding and Misrepresentation

Upcoding involves billing for a more expensive item than the one actually provided—for example, billing for a sophisticated power wheelchair when the patient received a basic manual model. These cases often turn on the accuracy of billing codes and documentation.

Medically Unnecessary Equipment

Prosecutors may allege that equipment was supplied to patients who did not medically need it, often based on prescriptions that were not properly supported by a legitimate physician evaluation.

Kickback Schemes

Paying or receiving anything of value in exchange for patient referrals or prescriptions is a common basis for both state and federal charges. Arrangements between DME suppliers, marketers, physicians, and recruiters draw intense scrutiny.

Phantom or Fraudulent Prescriptions

Allegations may involve prescriptions generated through telemarketing operations, fraudulent telemedicine consultations, or forged physician signatures, where there was no genuine doctor-patient relationship.

Identity Theft and Beneficiary Recruitment

Some cases involve the improper use of patient or provider identification numbers to submit claims, or the recruitment of Medicaid and Medicare beneficiaries who are paid to provide their information.

New York Laws Governing DME Fraud

Durable medical equipment fraud cases in New York City may be prosecuted under state law, federal law, or both. Defendants frequently face parallel criminal charges and civil enforcement actions arising from the same conduct.

New York Penal Law: Health Care Fraud

New York Penal Law Article 177 specifically addresses health care fraud. A person commits this offense by knowingly and willfully providing materially false information, or omitting material information, in order to receive payment from a health plan for services or supplies that the provider knew were not authorized or reimbursable. The severity of the charge—ranging from a Class A misdemeanor to a Class B felony—depends on the dollar amount fraudulently obtained:

Offense	Threshold Amount	Classification
Health Care Fraud in the 5th Degree	Any amount	Class A Misdemeanor
Health Care Fraud in the 4th Degree	Over $3,000	Class E Felony
Health Care Fraud in the 3rd Degree	Over $10,000	Class D Felony
Health Care Fraud in the 2nd Degree	Over $50,000	Class C Felony
Health Care Fraud in the 1st Degree	Over $1,000,000	Class B Felony

Grand Larceny and Related Charges

Prosecutors frequently pair health care fraud counts with grand larceny charges under New York Penal Law Article 155, as well as charges for falsifying business records, offering a false instrument for filing, and scheme to defraud. These additional counts can significantly increase the potential exposure a defendant faces.

New York False Claims Act

The New York False Claims Act allows the state to pursue civil penalties against those who submit false claims to government programs. This statute also permits whistleblowers—often former employees or business associates—to file lawsuits on behalf of the state and share in any recovery. Many DME fraud investigations begin with a whistleblower complaint.

Federal Statutes

Because Medicare and Medicaid involve federal funds, DME fraud is also prosecuted under federal statutes including the federal health care fraud statute, the Anti-Kickback Statute, the False Claims Act, and laws addressing mail fraud, wire fraud, and conspiracy. Federal cases in New York City are typically handled by United States Attorney's Offices and investigated by agencies such as the FBI and the Department of Health and Human Services Office of Inspector General.

Who Investigates DME Fraud in New York City?

Several agencies actively investigate durable medical equipment fraud across New York City. The New York State Office of the Medicaid Inspector General audits providers and identifies billing irregularities. The Medicaid Fraud Control Unit, operating within the New York State Attorney General's Office, investigates and prosecutes Medicaid provider fraud. District Attorneys in Manhattan, Brooklyn, Queens, the Bronx, and Staten Island also bring charges under state law.

On the federal side, investigations may be coordinated through the Medicare Fraud Strike Force, which combines federal prosecutors with investigative agencies to target healthcare fraud hotspots. These agencies often share information and may pursue coordinated state and federal action against the same individual or business.

Penalties and Consequences of DME Fraud Convictions

The consequences of a durable medical equipment fraud conviction extend far beyond the courtroom. Depending on the charges and the amount involved, penalties may include:

Incarceration: Felony health care fraud convictions can result in years of state prison time, with the most serious offenses carrying potential sentences of up to 25 years.
Restitution: Courts routinely order defendants to repay the full amount fraudulently obtained, which can total millions of dollars.
Fines and Civil Penalties: Both criminal fines and civil penalties under the False Claims Act may apply, with civil cases imposing treble damages and per-claim penalties.
Loss of Professional Licenses: Physicians, nurses, and other licensed professionals may face disciplinary action and loss of their licenses.
Program Exclusion: Conviction often results in exclusion from Medicaid, Medicare, and other federal healthcare programs, effectively ending a provider's ability to bill these programs.
Asset Forfeiture: The government may seek to seize assets and proceeds connected to the alleged fraud.
Immigration Consequences: Non-citizens may face deportation or other severe immigration consequences following a fraud conviction.

Beyond these formal penalties, a conviction or even a public investigation can devastate a professional reputation and destroy a business that has taken years to build.

How a DME Fraud Defense Attorney Can Help

Durable medical equipment fraud cases are document-intensive and technically complex. Effective defense requires a thorough understanding of medical billing, coding standards, regulatory requirements, and the methods investigators use to build their cases. Our attorneys approach each matter strategically, with the goal of resolving the case as favorably as possible—whether that means avoiding charges altogether, negotiating a favorable disposition, or winning at trial.

Early Intervention During Investigations

Many DME fraud cases begin quietly, with subpoenas, audit requests, or contact from investigators long before any charges are filed. Engaging an attorney at the earliest stage allows us to manage communications with the government, respond strategically to document requests, and in some cases persuade prosecutors not to bring charges at all. What you say and do during an investigation can determine the outcome of the entire case.

Challenging the Government's Evidence

DME fraud prosecutions rely heavily on billing records, claims data, medical documentation, and witness testimony. We carefully analyze whether the government can actually prove the required element of knowing and willful intent. Billing errors, documentation gaps, and good-faith reliance on the advice of billing professionals or coding software are not the same as fraud. We work with forensic accountants, medical billing experts, and other specialists to expose weaknesses in the prosecution's case.

Negotiating With Prosecutors

In appropriate cases, we negotiate with state and federal prosecutors to reduce charges, minimize penalties, or structure favorable resolutions. We understand how to present mitigating information and frame the facts in a way that protects our clients' interests and futures.

Defending at Trial

When a case cannot be resolved favorably before trial, we are prepared to present a vigorous defense before a jury. We hold the prosecution to its high burden of proof and challenge every element of the alleged offense.

Building a Strong Defense Against DME Fraud Charges

Every case is unique, but several defense strategies frequently prove effective in durable medical equipment fraud matters in New York City:

Lack of Intent

Health care fraud statutes require proof that the defendant acted knowingly and willfully. Complex billing rules, frequent regulatory changes, and reliance on staff or outside billing companies can produce honest mistakes. Demonstrating the absence of fraudulent intent can defeat the charges.

Medical Necessity and Proper Documentation

Where the government claims that equipment was unnecessary, we work with medical experts to establish that the items were appropriately prescribed and supported by legitimate clinical evidence.

Insufficient Evidence

The burden rests entirely with the prosecution. We scrutinize whether the government's evidence actually connects our client to the alleged fraud or relies on assumptions, unreliable witnesses, or flawed data analysis.

Constitutional Violations

If investigators conducted an unlawful search, exceeded the scope of a subpoena, or violated our client's rights, we move to suppress improperly obtained evidence.

Reliance on Professionals

Good-faith reliance on the advice of accountants, billing companies, or legal counsel can negate the intent required for a fraud conviction.

What to Do If You Are Under Investigation

If you suspect that you or your business is the subject of a durable medical equipment fraud investigation, taking the right steps early can make a critical difference:

Do not speak with investigators without counsel. Anything you say can be used against you. Politely decline to answer questions until you have spoken with an attorney.
Preserve all relevant records. Destroying or altering documents can lead to additional, often more serious, obstruction charges.
Do not contact potential witnesses about the investigation. This conduct can be construed as witness tampering.
Retain experienced defense counsel immediately. Early legal representation allows your attorney to protect your rights from the outset and influence the direction of the investigation.

Why Choose Our New York City DME Fraud Defense Attorneys

Durable medical equipment fraud cases demand attorneys who understand both the criminal justice system and the regulatory environment governing healthcare in New York. Our firm brings a focused, detail-oriented approach to these complex matters. We thoroughly investigate the facts, retain qualified experts, and develop a defense strategy tailored to the specific circumstances of each client.

We represent DME suppliers, business owners, physicians, billing personnel, and other individuals across all five boroughs. Whether you are facing an audit, responding to a subpoena, or defending against indictment, we are committed to protecting your freedom, your livelihood, and your reputation.

Contact a New York City DME Fraud Attorney Today

A durable medical equipment fraud allegation is a serious threat that requires prompt and skilled legal action. The earlier you involve an experienced defense attorney, the more options you may have to protect your interests. Our New York City legal team is prepared to evaluate your situation, explain your rights, and begin building a defense designed to achieve the best possible outcome.

If you are under investigation or facing charges for durable medical equipment fraud in New York City, contact our office today to schedule a confidential consultation. Do not wait until the situation worsens—take the first step toward protecting your future now.

You can contact us by phone at 212-233-1233 or by email at [email protected].