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Federal Health Care Fraud 18 U.S.C Section 1347

Federal health care fraud

Federal health care fraud per 18 U.S.C section 1347, makes it unlawful 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.

Federal Health Care Fraud Burden of Proof

The burden of proof is always on the federal government to prove that you committed the alleged fraud beyond a reasonable doubt. In order for a defendant to be convicted of federal health care fraud under 18 U.S.C section 1347 the prosecutor must prove:

  • 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; and
  • Defendant acted knowingly and willfully

18 US Code Section 1347 Applies to All Health Care Benefit Program Fraud

A “health care benefit program” is defined in 18 U.S.C section 24(b), as 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.

Penalties/Punishment for a 18 U.S.C Section 1347 Federal Health Care Fraud Conviction

Penalties/punishments for a federal health care fraud per 18 U.S.C section 1347 conviction include:

  • Up to 10 years in federal prison; and/or
  • A fine up to $250,000 for individual defendant and a fine of up to $500,000 for organizations

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

Common Examples of Federal Heath Care Fraud

A few common examples of federal health care fraud include:

  • Medicare fraud;
  • Medicaid fraud;
  • Billing fraud;
  • Hospice medical billing fraud;
  • Department of Labor (“DOL”) health plans and benefit fraud;
  • Private health insurance fraud;
  • Tricare fraud;
  • Forging prescriptions;
  • Upcoming;
  • Making false or fraudulent claims;
  • Obtaining healthcare coverage by providing false information
  • HIPAA (Health Insurance Portability and Accountability Act) violations;
  • Veteran’s Administration (“VA”) healthcare benefits fraud
  • Kickbacks;
  • Upcoding;
  • Using false billing codes;
  • Billing for services, equipment or supplies that were not provided;
  • Falsifying medical records; and
  • Performing unnecessary procedures

Should I Hire an Federal Health Care Fraud Defense Attorney If I am Under Investigation?

Whenever possible, it is better to retain an federal health care fraud defense attorney at the outset in order to help level out the playing field. This includes retaining an attorney as soon as you become aware of any investigation(s) made against you.In doing so, the defense can investigate and challenge the evidence founds, the procedures that are being used by the investigators, etc.

Aggressive Federal Health Care Fraud Defense Attorney

It is imperative to contact a experienced and aggressive criminal defense attorney when facing federal health care fraud charges. More specifically, it is likewise imperative to hire an defense attorney who has experience in handling health care fraud at the federal court level.

If you or a loved one is under investigation or has been arrested for federal heath care fraud charges in California, we invite you to contact our federal health care fraud defense attorney at (213) 248-6784 for free consultation.

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