Healthcare fraud is a prevalent crime. Federal healthcare fraud involves fraudulent conduct with respect to any federal healthcare program or plan that provides health benefits to an individual. The plan or program is funded by the United States either directly or by way of a state healthcare fund.
Healthcare fraud involves either a healthcare provider or individual's attempt to defraud the federal government with respect to the receipt of healthcare payment or benefits. If one is charged with healthcare fraud the prosecution must show that:
If one is convicted of healthcare fraud, he or she may be fined up to $25,000, may be sentenced to up to ten years in prison, or both. If the defendant's conduct resulted in seriously bodily injury, the defendant may be sentenced to up to 20 years in prison.
Kickbacks of any sort are prohibited. The applicable federal statute provides that any individual, who knowingly or willfully receives or solicits cash or any other type of property as a kickback, may be guilty of healthcare fraud. The specific elements of the offense include:
If a healthcare provider or individual gives false statements with respect to the application of healthcare benefits or payments under any federal health care programs, healthcare fraud may have resulted.
Depending upon the facts of any given case, the prosecution must show that the provider or individual:
If an individual is convicted of making false statements, he may be sentenced up to five years imprisonment; he may be fined up to $25,000, or both.
Theft or Embezzlement
If the healthcare provider or individual defendant embezzles or misapplies any assets of any healthcare program, the defendant may be charged with theft or embezzlement. If the offense involves an amount of less than $ 100, the defendant may be fined, sentenced to one-year imprisonment, or both. If the offense involved an amount exceeding $100 and the defendant is convicted, the defendant may be fined, sentenced to not more than ten years in prison, or both.
The healthcare provider or individual defendant may also be charged with mail or wire fraud or obstruction of a criminal investigation in conjunction with the underlying healthcare fraud charge. For a conviction of either of the above-mentioned offenses, the defendant may be fined, sentenced to up to five years in prison, or both.
Copyright 2014 LexisNexis, a division of Reed Elsevier Inc.