Federal Health Care Fraud

There are hundreds of convictions each year for federal healthcare fraud-related crimes, which include cases where a governmental or private healthcare entity was the one defrauded. Given the cost of health care in the U.S., it's not surprising that, according to the United States Sentencing Commission, the median amount of the loss involved in a typical health care fraud case has been $1 million or more for a number of years. And while it may seem like a so-called “victimless crime, healthcare fraud is the kind of crime that spreads its damage around by incrementally making healthcare more expensive for everybody.

The Federal Health Care Fraud Statute

While there are a number of crimes that may make up a typical health care fraud case (such as mail or wire fraud or conspiracy), 18 U.S.C. §1347 is the Health Care Fraud statute that prohibits anyone from “knowingly and willfully” defrauding (or attempting to defraud) “any health care benefit program.” The statute also prohibits using “false or fraudulent pretenses” to get money or equipment owned by any healthcare benefit program in connection with the delivery or payment of health care benefits.

Penalties for violating §1347 include a fine of up to $250,000 and a prison term of up to ten years, up to twenty years if someone is seriously injured as a result of a violation of the statute, and up to life in prison if someone dies as a result.

Other Statutes Can Apply as Well

As with many financially-oriented crimes, if you accept money that you are not legally entitled to receive and move that money from one person or account to another, or if you involve any other people in your efforts, there are a number of other charges that federal government may be able to bring against you. These include mail and wire fraud as well as conspiracy to commit any of those or, in this case, to commit health care fraud. Each of these other statutes has its own penalty that could be added on top of those imposed for violating the health care fraud statute.

Many First-Time Offenders

Given the relatively large amounts involved in a typical case (more than 80% of cases in 2021 involved fraud in excess of $150,000, and more than 15% involved losses greater than $9.5 million), it may be surprising to learn that according to the U.S. Sentencing Commission, the vast majority of people convicted of health care fraud – over 90% -- had little or no criminal history. This means that for most people who find themselves committing health care fraud, the act of committing that crime is likely to be a new experience, one that can be intensely uncomfortable and difficult to deal with. It is not unusual in these kinds of situations for the people involved to do nothing, hoping it will all just go away. That, however, is a mistake.

If you find yourself in a situation where you are or may be committing health care fraud and have not yet been caught or are being investigated for possible health care fraud crimes, it is extremely important that you secure the help of an experienced criminal law attorney to advise and defend you as soon as possible. The sooner you do so, the more likely it is that the situation can be resolved in a way that reduces the possibility of charges being filed against you. By contacting our Criminal Law Team– attorneys with years of experience helping clients resolve federal and state criminal charges in Pennsylvania and elsewhere – you will take that first important step towards remedying a situation that may feel like it is spiraling out of your control.

A Conviction Likely Means Jail Time

Another important reason to deal with potential healthcare fraud situations before they result in charges is the fact that more than 70% of healthcare convictions in 2021 resulted in prison sentences, with the average sentence being 30 months. There is thus a realistic likelihood that if you are charged and convicted of a healthcare fraud crime, you will go to jail. This is another reason to contact an experienced criminal law attorney such as the ones on our Criminal Law Team if you find yourself charged in a healthcare fraud case. Our Criminal Law Team and the LLF Law Firm regularly defend clients charged with serious federal and state crimes and know how to protect your rights as a citizen and as a defendant.

Criminal sentences are not set in stone. In the federal system, there are guidelines that courts follow that allow for both downward and upward departures from recommended sentences in certain situations. If you are unfortunate enough to have been convicted of health care fraud and have not yet been sentenced, having our Criminal Law Team on your side to bring the judge's attention to each and every possible reason to reduce your sentence below the guideline levels can mean the difference between having to spend years behind bars and only spending a few months in jail.

These Are Crimes of Intent

Receiving and paying for health care in the U.S. can be a very confusing experience. When it comes to record-keeping and billing practices, innocent mistakes are made all of the time, and sometimes these mistakes can mean ordinary people receive health care benefits but are billed incorrectly. While it may seem that those billing errors typically are in favor of the doctor, hospital, or clinic doing the billing, it's not unusual for errors to be in the consumer's favor. But making an honest mistake does not mean you necessarily intended to defraud anybody. If you've been charged with healthcare fraud over what you believe was an honest mistake, you need to speak with an experienced criminal defense lawyer.

Our Criminal Law Team Can Help

If you find yourself being investigated for or charged with healthcare fraud, you need to contact our Criminal Law Team and the LLF Law Firm as soon as possible. Our Criminal Law Team has years of experience representing good people who find themselves in difficult legal situations, charged with complicated crimes by government prosecutors who are not interested in helping the targeted defendants. Our Criminal Law Team knows the laws, knows the system, and knows how to protect your rights in these kinds of cases. Contact our Criminal Law Team today at 888-555-3686 or through the LLF Law Firm online form to learn more about how we can help you.

Contact Us Today!

The LLF Law Firm Team has decades of experience successfully resolving clients' criminal charges in Philadelphia and the Pennsylvania counties. If you are having any uncertainties about what the future may hold for you or a loved one, contact the LLF Law Firm today! Our Criminal Defense Team will go above and beyond the needs of any client, and will fight until the final bell rings.

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