Health care fraud is the category of federal fraud crimes that involve the misappropriation of benefits the federal government has made available for legitimate medical care services. Tricking the government into handing over taxpayer dollars or any government property is a crime. Federal authorities have zero tolerance for persons that steal or attempt to steal from taxpayers.
The most commonly used federal statutes deployed by United States Attorneys in health care fraud cases are health care fraud under 18 U.S.C. § 1347 and false statements relating to health care matters under 18 U.S.C. § 1035.
More recently, charges for organized crime schemes, such as the Racketeer Influenced and Corrupt Organizations (RICO) Act, which you can learn more about here, have become more common in health care fraud cases due to its lucrative payout.
Additionally, you may also see the more ubiquitous charges under 18 U.S.C. §§ 1341, 1343, or mail and wire fraud, which you can learn more about here. Moreover, against weaker cases or for added leverage, an indictment might also include charges of false statements under 18 U.S.C. § 1001 or fraudulent claims under 18 U.S.C. § 287. You can learn more about false statements here.
Health care fraud requires proof that the defendant knowingly and willfully executed or attempted to execute a scheme to defraud a federal health care program.
Similar to other fraud charges, health care fraud under section 1347 requires proof of a scheme to defraud, and you can learn more about proving a scheme to defraud here.
Health care fraud cases can implicate medical practitioners or recipients of federal health care benefits.
Examples of things often found in cases involving health care providers include:
Examples of things often found in cases involving health care recipients include:
The Federal Bureau of Investigation (FBI) and the Department of Justice (DOJ) are the most likely agencies investigating persons suspected of health care fraud, as these two are the main law enforcement agencies of the federal government.
Considering that this charge applies to entire federal health care benefits under federal law, the Department of Health & Human Services (DHHS) might be involved in an investigation.
Private organizations such health insurance providers and the National Health Care Anti-Fraud Association (NHCAA) would likely be involved in an investigation as well.
The punishment for health care fraud most often includes an assessment of heavy fines and a term of imprisonment, but sentencing varies with each case’s unique set of facts, the presiding judge, and factors considered under the federal sentencing guidelines, which you can read more about here.
Yes, these health care fraud charges are felonies under federal law.
10 years is generally the maximum term of imprisonment for health care fraud under section 1347, but the term would increase in situations below.
20 years is the maximum term of imprisonment for health care fraud cases in which the fraud results in serious bodily injury, meaning that it involves another person experiencing:
A life sentence for maximum imprisonment term for health care fraud cases in which the fraud results in death of an another individual.
Every sentence in a federal cases is based on the federal sentencing guidelines, which considers a multitude of factors, such as prior criminal history, use of a gun, or position of trust, to calculate a recommended range that the federal judge may use as a guide for sentencing, however the presiding judge ultimately reserves final discretion at sentencing. Thus, as long as the judge provides a reasonable basis for their decision on record, the judge may make what is called a “departure from the guidelines” and sentence the defendant to a term of imprisonment outside the recommended range. You can learn more about the sentencing under the federal sentencing guidelines here.
Possibly, as it depends on the charges you are convicted of and the unique facts of your case. Ultimately, however, final discretion remains with the judge presiding over sentencing. Factors that also will help determine whether restitution will be required include whether there are victims of the convicted charges, whether those victims suffered compensable harm, the federal sentencing guidelines, and many more.
Possibly, as it again depends on the charges alleged in the indictment and the unique facts of your case As mentioned above, the charges and facts alleged in the indictment shape the scope of the entire criminal proceeding, including assets subject to pre-trial seizures and final forfeiture as part of sentencing, if convicted. You can learn more about the sentencing under the federal sentencing guidelines here.
See our news page for recent updates on COVID-19 disaster fraud cases here.
You should only speak with law enforcement investigator regarding anything related to COVID-19 fraud or any other related crime after you have spoken to a criminal defense lawyer. Period.
A common question from people involved in a criminal investigation is at what point can they finally clear their name and share their part of the story.
You have probably heard investigators, prosecutors, and others taking the situation out of context, bending the truth, and misunderstanding what actually happened. They are relying on people who are lying, and the whole situation is outrageous and humiliating for you.
You should know that the Fifth Amendment exists to protect anyone accused of a crime from incriminating themselves, and the truth is it takes only one split-second mistake to get unnecessarily tied up in a prolonged criminal investigation that will place a heavy financial and time-consuming burden for you and loved ones. Do not go swimming with sharks alone and without a cage.
You need to speak with a COVID-19 fraud defense attorney to obtain sound legal advice before you speak with federal investigators, even if you think you have done nothing wrong.
You should contact a defense lawyer that has decades of experience handling criminal investigations before you engage with investigators. Balancing cooperation and protecting your constitutional rights and liberties requires a defense attorney that knows how to handle federal investigators.
If you have been contacted or anticipate contact from federal COVID-19 fraud investigators, then you should contact and speak with a COVID-19 fraud defense lawyer to protect yourself, your freedom, and financial stability. You will not be able to talk yourself out of the crosshairs – you’ll only be wound up in a web of investigation tactics.
You need a fraud defense lawyer who knows what they’re doing and has a proven track record of experience defending federal fraud cases. Schiffer law firm has over four decades of experience defending clients involved in federal criminal investigations and clients accused of federal crimes. The fraud defense lawyers at Schiffer law firm know how to handle federal fraud cases from first contact by investigators to overturning wrongful convictions on appeal.
Schiffer law firm attorneys have and continue to defend people needing fraud defense attorneys nationwide. Nobody is too small, and nowhere is too far. If you think you need to speak to a fraud defense attorney, give us a call today.