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Federal Health Care Fraud 18 U.S. Code § 1347

Federal Health Care Fraud

Under Federal Health Care Fraud, per 18 US Code Section 1347 it is prohibited to knowingly and willfully execute, or attempt to execute, a scheme or artifice to defraud any health care benefit program; or 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.

Elements of Federal Health Care Fraud

The prosecutor must establish the following elements to convict the defendant under Federal Health Care Fraud US Code Section 1347:

  • Defendant executed or attempted to execute a scheme to defraud any health care benefit program
  • Fraud was connected with the delivery or payment of health care services or benefits
  • Defendant acted knowingly and willfully

Defendant Executed or Attempted to Execute a Fraudulent Act

According to 18 US Code Section 1347, an attempt to commit health care fraud is punishable to the same extent as the commission of fraud. An “attempt” is consist of intention to commit illegal conduct and a “substantial step” toward its commission.

Acting Knowingly and Willfully

To be found guilty of health care fraud under 18 US Code Section 1347, it is necessary to knowingly and willfully execute an illegal scheme. While presenting proof of actual knowledge is one way that the prosecution can get a conviction, sometimes, constructive knowledge can be enough to establish criminal culpability for health care fraud. In case the defendant was aware of a high potential for fraudulent conduct and took steps to intentionally avoid learning about it, in some cases this can be enough to establish knowledge.

Health Care Benefit Program Fraud

18 US Code Section 1347 applies to fraud targeting all health care benefit programs. According to 18 US Code Section 24(b), a “health care benefit program” is any public or private plan or contract, affecting commerce, under which any medical benefit, item, or service is provided to any individual, and includes any individual or entity who is providing a medical benefit, item, or service for which payment may be made under the plan or contract.

Examples of Health Care Fraud

Health care fraud covers many white collar crimes and it can include the following types of conduct:

  • Medicare and Medicaid fraud
  • Billing fraud
  • HIPAA (Health Insurance Portability and Accountability Act) violations
  • Falsifying medical records
  • Insurance fraud
  • Kickbacks
  • Unbundling
  • Performing unnecessary procedures

Penalties for Violating 18 U.S. Code Section 1347

18 U.S. Code Section 1347 imposes severe penalties for health care fraud.

The penalties are the following:

  • Up to 10 years in federal prison
  • Fines of up to $250,000 for individuals or fines of up to $500,000 for organizations

If the fraudulent actions resulted in serious bodily injury the defendant can face of up to 20 years in federal prison. If the fraud resulted in death the defendant can face a life sentence.

Federal Health Care Fraud Attorney

Contact the criminal defense attorneys at KAASS LAW if you or a loved one has been arrested for Federal Heath Care Fraud charges. Call (310) 943-1171 or set up an appointment to set up a free consultation with a Federal health care fraud attorney.

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