Title 18 U.S.C. § 1347 - Federal Health Care Fraud Law
18 U.S.C. § 1347 makes it a federal offense to defraud a health care benefit program or to obtain any money from one fraudulently. A crucial element in any federal health care fraud case is the "intent to defraud."
Typically, this intent is proven when pretenses, promises, or misrepresentations are used to acquire money or services you are not entitled to.
The manner of fraud can differ based on the specific benefit program or whether the goal is to acquire cash or valuable services.
For example, you might falsely claim to meet the eligibility criteria for a particular healthcare benefit program when you do not qualify.
What is "Means Testing?"
Many programs require recipients to be below a certain income level, called "means testing," which is common across numerous federal benefit programs.
For instance, if you know the income limit is $40,000 per year but your actual income exceeds this, you would be ineligible for the healthcare benefits.
However, when filling out the registration paperwork to receive healthcare benefits, you falsely claim an income of under $40,000 to qualify.
Once you receive either subsidized medical treatment or a cash benefit, you have committed healthcare benefits fraud because you knowingly provided false information to obtain services or payments you were not entitled to.
Making Fraudulent Statements
Knowing that engaging in fraudulent conduct is illegal under federal laws is not necessary for a conviction.
Simply making fraudulent statements or representations to obtain money or services through a federal healthcare benefit program is enough to be convicted.
Violating 18 U.S.C. § 1347 for federal healthcare fraud can lead to penalties of up to 10 years in federal prison and/or a fine.
If the violation causes serious bodily injury, the sentence can be increased to 20 years. If it results in death, the maximum penalty could be a life sentence.
Health Care Fraud Conspiracy - 18 U.S.C. 1349
Under 18 U.S.C. § 1349, federal healthcare fraud can be charged as conspiracy if one or more individuals agree to commit healthcare fraud. This can take many forms.
For example, a group might conspire to recruit others to claim eligibility for federal healthcare benefits and send these individuals to a doctor involved in the conspiracy.
Community members may receive payments, or "kickbacks," while the doctor gets reimbursed by the federal benefits program for providing medical services to those recruited.
In truth, the doctor did not deliver the services they claimed to have received from the government. Instead, their role in recruiting patients, performed by so-called "cappers" or recruiters, involved receiving kickbacks.
The conspiracy operates by fraudulently distributing federal healthcare benefit funds to various members.
Recruiting Patients is Prohibited
Everyone involved, including the doctor, recruited patients, and the "cappers," knew their activities were fraudulent, and all could face charges under 18 U.S.C. § 1349 for federal healthcare fraud conspiracy.
A conspiracy to commit healthcare fraud can lead to penalties of up to 10, 20, or even life imprisonment in federal court, especially if injury or death occurs.
If you or a family member is under investigation or facing federal healthcare fraud charges under 18 U.S.C. § 1347 or 1349, contact our experienced federal criminal defense attorneys for a consultation.
We will protect your rights during the investigation phase, before formal charges are filed, and can help negotiate a pre-indictment resolution with the prosecutor or defend your case in federal court, including jury trials. Reach out to the Hedding Law Firm for a case evaluation.
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