Under Federal Health Care Fraud, per 18 US Code Section 1347 it is prohibited 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.
The prosecutor must establish the following elements to convict the defendant under Federal Health Care Fraud US Code Section 1347:
According to 18 US Code Section 1347, an attempt to commit health care fraud is punishable to the same extent as the commission of fraud. An “attempt” is consist of intention to commit illegal conduct and a “substantial step” toward its commission.
To be found guilty of health care fraud under 18 US Code Section 1347, it is necessary to knowingly and willfully execute an illegal scheme. While presenting proof of actual knowledge is one way that the prosecution can get a conviction, sometimes, constructive knowledge can be enough to establish criminal culpability for health care fraud. In case the defendant was aware of a high potential for fraudulent conduct and took steps to intentionally avoid learning about it, in some cases this can be enough to establish knowledge.
18 US Code Section 1347 applies to fraud targeting all health care benefit programs. According to 18 US Code Section 24(b), a “health care benefit program” is 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.
Health care fraud covers many white collar crimes and it can include the following types of conduct:
18 U.S. Code Section 1347 imposes severe penalties for health care fraud. The penalties are the following:
If the fraudulent actions resulted in serious bodily injury the defendant can face of up to 20 years in federal prison. If the fraud resulted in death the defendant can face a life sentence.
Contact the criminal defense attorneys at KAASS LAW if you or a loved one has been arrested for Federal Heath Care Fraud charges. Call (310) 943-1171 or set up an appointment to set up a free consultation with a Federal health care fraud attorney.
California Penal Code Section 550(a) covers and defines healthcare fraud, which sometimes is also referred to as health insurance fraud and medical billing fraud. Healthcare fraud is submission of false claims or disinformation of healthcare insurers about care or services that may or may not have been provided. Penal Code Section 550(a) lists a range of unlawful conduct and here are some examples that could lead to California health care fraud charges:
To convict a person in health care fraud, the prosecutor has to do prove his engagement in one of the unlawful behaviors described in Penal Code Section 550(a) and also two additional elements of the crime.
These types of crimes are usually committed by health care providers including chiropractors, physical therapists, nurses, nurse practitioners, dentists, and administrators. If convicted of health care fraud, professional licenses can be suspended or revoked.
In California penalties for health care fraud depend on the amount of the fraudulent claim. Health care fraud claims of $950 or less. In case the claim is $950 or less then the health care fraud is a misdemeanor.
Penalties for misdemeanor medical and or health care fraud depend on the amount of the fraudulent claim, but may include the following:
In case the fraud was more than $950, then the crime of health care fraud is considered a wobbler. The defendant can be charged with either a misdemeanor or a felony conviction. Penalties for a misdemeanor conviction are:
Penalties for felony medical and or health care fraud include the following:
In case the charges involve more than one claim, then the key question is whether all the claims add up to more than $950 in twelve months period.
Hire the most dedicated California medical fraud defense lawyer to help defend and fight your Penal Code 186.10 charges. Our attorneys at KAASS LAW are highly dedicated to help our clients in every way possible. You can rely on our experienced lawyers in Glendale, Los Angeles, California, to carefully analyze the facts of your case to prove the facts necessary. We back all of our clients and we invite you to give us a toll free call at (310) 943-1171 to speak to our experienced Glendale criminal battery attorney today. Get in touch with us at KAASS LAW, 815 E Colorado St #220, Glendale, CA 91205, (310) 943-1171 at any time.