Healthcare Fraud Laws & Charges

Health care fraud is a form of white collar crime. It involves filing illegitimate health care claims to turn an illicit profit. Fraudulent health care cases take many forms at the state and federal level. Some of the most common health care fraud schemes include:

  • Billing Medicare or Medicaid for services never performed
  • Billing a non-covered service as a service that is covered
  • Changing medical records
  • Intentional improper reporting of diagnoses to increase payment from federal programs
  • Modifying medical records to increase reimbursements from federal programs
  • Forging or selling of prescription medications
  • Getting unneeded prescription drugs and selling them

The federal government takes health care fraud very seriously, both perpetuated by medical providers and patients. Generally, the health care provider ends up passing on costs from fraud onto consumers. It is believed that .10 of every one dollar spent on health care is spent on health care fraud expenses.

Healthcare Fraud Laws

Anyone who commits health care fraud can be charged with the federal crime as described in 18 USC 1347. Under that federal law, you can be found guilty of health care fraud if you willingly and knowingly execute, or try to execute a scheme to defraud any federal health care benefit program, or obtain any money or property under false pretenses that is under the control of a federal health care benefit program.

Note that this federal law states that regarding the violations listed above, you do not need to have knowledge of the laws against health care fraud to be guilty of the crime in a court of law.

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Healthcare Crimes and Charges

Some of the most common types of healthcare fraud crimes include:

  • Billing for non-rendered services
  • Misrepresenting when services were done
  • Waiving deductibles or copayments
  • Overusing services
  • Bribery and kickbacks
  • Misrepresentation of where services were performed
  • Improper reporting of diagnoses or procedures
  • Billing a non covered service as covered

Recent examples of healthcare fraud cases include a LA woman sentenced in September 2013 for 37 months. She was convicted of health care fraud and money laundering. She operated two companies and used unlicensed social workers to visit Medicare patients. She submitted false claims to Medicare.

Also, a West Virginia chiropractor was sentenced in September 2013 for health care fraud and tax evasion. He submitted false claims to a health care benefit program and committed tax evasion in 2008.

Healthcare Fraud Sentence Guidelines

18 USC 1347 states that anyone who attempts to defraud a federal health care benefit program can be sentenced to up to 10 years in prison for each count. If the violation causes bodily injury, such as when a medical provider performs an unneeded medical procedure, the penalty can be a prison term of up to 20 years. If the violation causes a patient death, the provider can be sentenced to life in prison.

Healthcare Fraud Statute of Limitations

The federal statute 18 USC 3282 stipulates that you cannot be prosecuted, tried or punished for any type of non capital offense, unless the indictment is processed within five years that the offense was committed. This applies to crimes of health care fraud.

Healthcare Fraud News

Russian Diplomats Charged With Healthcare Fraud

US Prosecutors this week charged 49 Russian diplomats and family members with health care fraud, by trying to get health benefits intended for poor people.

Ohio Woman Sentenced for $2 Healthcare Fraud Scheme

The owner of the Three Rivers Infusion Pharmacy in Coshocton OH was sentenced to 54 months in prison for health care fraud.

IRS Must Be Vigilant on Health Care Fraud

An IG report by the US government noted that the IRS needs to develop better health care fraud detection.

Houston TX Man Sentenced to Four Years for Healthcare Fraud

A federal judge this week sentenced a Houston TX man to four years in prison for a $10 million healthcare fraud scheme.


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