Health Care Fraud Involves a Variety of Different Crimes

Health Care Fraud Involves a Variety of Different Crimes

Under federal law, it is Health Care Fraud when a person “knowingly and willfully executes, or attempts to execute, a scheme:

(1) to defraud any health care benefit program; or

(2) 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, in connection with the delivery of or payment for health care benefits, items, or services[.]”

18 U.S.C. § 1347(a). Under the code, a person “shall” be fined and/or imprisoned for up to 10 years. If the violation results in serious bodily injury, the person shall be fined and/or imprisoned for up to 20 years. If death results from the violation, a sentence to life in prison is possible. Knowledge of this law or specific intent to violate it is not a necessary element of the crime. 18 U.S.C. § 1347(b).

Health Care Fraud Involves a Variety of Different Crimes

While Health care fraud is a codified crime under federal law, health care fraud schemes typically involve a variety of different crimes. Prosecutors will bring charges for as many crimes as possible based on the facts and evidence they have. The more crimes that are charged, the more likely a prosecutor is to secure a conviction. Multiple charges arising out of the same case also gives prosecutors negotiating room to drop charges or reduce charges when seeking plea agreements.

Health care fraud allegations may include charges for:

Not only do fraudulent health care schemes involve multiple crimes, they can be carried out in a number of ways. Provider health care fraud can include billing for care that was never rendered, filing duplicate claims for the same medical service, billing for services that were not medically necessary, upcoding the billing to get paid for a more expensive procedure than was actually performed, accepting or giving kickbacks for member referrals, obtaining covered prescription drugs and then selling them on the black market for a profit, or billing for medical equipment that was never provided.

Health Care Fraud Defense

Criminal charges for health care fraud and accompanying crimes are prosecuted aggressively. If you have been accused of involvement in a health care fraud scheme, you need a defense attorney experienced in handing health care fraud cases who can combat aggressive prosecutors.

As a former health care fraud prosecutor with the United States Attorney’s Office, Ashley D. Adams understands the tactics and procedures the government will use to obtain a conviction. She understands how prosecutors operate, and the best legal strategies to mount a strong defense against health care fraud allegations. Given her prior work, she also has a longstanding and positive relationship with the U.S. Attorney’s Office, the Attorney General’s Office, and the Department of Justice. Put Ashley D. Adam’s experience to work for you.

Contact us or call now (480) 219-1366 for a consultation.


The attorneys at Ashley D. Adams, PLC handles federal criminal cases throughout the United States, including Arizona, Oklahoma, Utah, and California.