Health Care Fraud

Health care fraud is a serious offense that involves the intentional deception or misrepresentation of information to gain unauthorized benefits from health care programs. This type of fraud can take many forms, including billing for services not rendered, falsifying diagnoses to justify unnecessary tests, and misrepresenting the cost of services. Health care fraud not only results in significant financial losses but also undermines the integrity of health care systems.

Generally, federal officials will seek charges under 18 U.S.C. § 1347(a).

The elements for this section are:

(a)Whoever knowingly and willfully executes, or attempts to execute, a scheme or artifice—

(1) to defraud any health care benefit program; or

(2) to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program, in connection with the delivery of or payment for health care benefits, items, or services, shall be fined under this title or imprisoned not more than 10 years, or both. If the violation results in serious bodily injury (as defined in section 1365 of this title), such person shall be fined under this title or imprisoned not more than 20 years, or both; and if the violation results in death, such person shall be fined under this title, or imprisoned for any term of years or for life, or both.

(b) With respect to violations of this section, a person need not have actual knowledge of this section or specific intent to commit a violation of this section.

What does this mean?

Title 18 U.S.C., Section 1347 makes it a federal crime to defraud any health care benefit program or obtain, by fraudulent means, any money from a health care benefit program. One of the fundamental elements of health care fraud is the intent to defraud.

What must the government prove in a health care fraud case?

To prove health care fraud, the Government must show that the defendant either (1) knowingly and willfully executed, or attempted to execute, a scheme or artifice to defraud a health care benefit program; or (2) knowingly and willfully executed, or attempted to execute, a scheme or artifice to obtain, by means of false or fraudulent pretenses, money under the control of a health care benefit program.

What is a conspiracy to commit health care fraud?

Conspiracy to commit health care fraud is also a federal crime under 18 U.S.C.S. § 1349. To prove a conspiracy to commit health care fraud, the government must show beyond a reasonable doubt that: (1) two or more persons made an agreement to commit health care fraud; (2) that the defendant knew the unlawful purpose of the agreement; and (3) that the defendant joined in the agreement with the intent to further the unlawful purpose. United States v. Sanders, 952 F.3d 263.

What is the punishment for violating 18 U.S.C. Sec. 1347?

Violating this section is punishable by:

            A maximum of 10 years in federal prison and/or

            A fine

            The sentence maximum of increases to 20 years if the violation resulted in serious bodily injury.

Federal Government’s Expansive Resources

The federal government dedicates substantial resources to investigating and prosecuting health care fraud. Agencies such as the Department of Justice (DOJ), the Federal Bureau of Investigation (FBI), and the Department of Health and Human Services Office of Inspector General (HHS-OIG) work collaboratively to identify and pursue fraudulent activities. This extensive network of resources underscores the importance of mounting a robust defense when facing health care fraud charges.

What do to do if you are charged with or under investigation for crimes related to health care fraud?

If you are charged with or under investigation for health care fraud, contact a Federal Health Care Fraud Defense Attorney. As a former federal health care fraud prosecutor, Robert Almonte gained unique expertise to evaluate and defend charges against you involving health care fraud.

Robert Almonte will fully evaluate your case and examine each fact to determine the best outcome for your case, including formulating defenses or pre-indictment resolutions. Robert Almonte can protect your rights at every stage of the process, including the investigative stage and prior to the formal filing of indictment.

Contact us today to schedule a confidential and discreet consultation.