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A quick look at some federal statutes under which health care fraud charges may be pursued

In our last post, we mentioned that health care fraud can result in serious civil penalties, as well as possible criminal charges for those who are accused. As we noted, the actual consequences of health care fraud depend, among other things, on the statute under which charges are pursued. At the federal level, there are a variety of laws targeting health care fraud, but not all of them involve criminal penalties.

The False Claims Act, which we mentioned last time, does include possible criminal prosecution. If found guilty of knowingly making a false claim, a defendant could face significant criminal fines and spend time in prison. Health care fraud charges, then, are no small matters. Hence the need of working with an experienced defense attorney.  

Another federal statute under which criminal charges for health care fraud may be imposed is the anti-kickback statute, which prohibits physicians from knowingly and willfully offering payment in exchange for referring an individual for health care items or services for which payment may be made under a federal health care program. Most often, this occurs in connection with Medicare and Medicaid.

Under the Health Care Fraud Statute, it is a crime to knowingly and willfully carry out a plan to defraud a health care benefit program. Penalties can be up to 10 years in prison and may include a fine of as much as $250,000. Prosecutors do not need to prove specific intent to violate the statute to be convicted.

Regardless of the statute under which health care fraud charges are pursued, it is important to work with an experienced criminal defense attorney to build the strongest possible defense case. 

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