There are many different types of health care fraud offenses in federal court.
Here are some of the ones most frequently used by federal prosecutors when they charge a person with a health care fraud offense in federal court:
Health Care Fraud (18 U.S.C. §1347) – This code section is the basic health care fraud statute in federal court. This law makes it illegal to make a false statement or promise to defraud a health care program. This law covers fraud involving both government-sponsored health care programs and private insurance companies. The penalty for this type of health care fraud is up to 10 years in prison, although the federal sentencing guidelines may call for a much lower sentence depending on the amount of money involved in the case.
Health Care Fraud Conspiracy (18 U.S.C. §1349) – This code section covers conspiracies to commit a healthcare fraud offense. This law makes it illegal for two or more people to agree to a scheme or plan to commit some form of health care fraud. The plan doesn’t have to be successful for someone to be convicted of this crime. All the government has to prove is that there was an agreement to do something that violates the health care fraud laws. While there are several different conspiracy laws that may apply in a health care fraud case, this is the one we see prosecutors use most often. A person convicted of a health care fraud conspiracy faces up to 10 years in prison.
Wire and Mail Fraud (18 U.S.C. §§ 1341 and 1343) – This code section covers any type of fraud, not just health care fraud, where a person uses the mail or some type of wire communication to cheat someone out of money. Although these sections can cover the same type of conduct covered by the basic health care fraud statute, prosecutors like to use these offenses so they can threaten a defendant with a lengthier sentence. A person convicted of wire or mail fraud faces up to 20 years in prison in most cases.
False Claims Law (18 U.S.C. §287) – This code section makes it illegal to submit a false claim (like an invoice for medical services or equipment) to the government for payment. Most cases brought under the False Claims Act involve a health care provider submitting bills for medical services or equipment not provided to a patient, or that were not medically necessary for the patient. The penalty for violating this law is a sentence of up to 5 years in prison.
Anti-Kickback Law (42 U.S.C. §1320a-7b) – This law makes it illegal for someone to pay or receive a “kickback” (a bribe, gratuity or other payment) in connection for medical services or equipment paid for by a government sponsored health care program. Most anti-kickback cases involve money or other benefits given to a doctor or clinic for referring patients or sending business to another health care provider. This section only covers bills sent to a government health care program, like Medicare, Medicaid or TRICARE. A violation of this law carries a sentence of up to 5 years in prison, although the specific sentence will usually be based on the federal sentencing guidelines.