U.S. federal law includes strict prohibitions against fraud committed in the Medicare or larger health care context. In terms of Medicare, specifically, it is a health insurance program offered by the U.S. federal government. Under this program, individuals and those over 65 years old can receive medical benefits and services. Accordingly, Medicare is considered a health care benefit program and subject to U.S. federal law. And if a person commits Medicare fraud, it is considered a federal health care offense.
What is the definition of Federal Health Care Program or Offense?
18 U.S. Code § 24 establishes that the term “health care benefit program” refers to both public and private plans that affect commerce and provide any medical benefit or service. Individuals and entities providing such medical benefits or services are included in the definition of a health care benefit program.
On a related note, Section 24 also defines the term “federal health care offense.” This term refers to the violation – or conspiracy to violate – various federal laws affecting health care. In this sense, any violation, attempt, or conspiracy involving Medicare fraud would likely qualify as a federal health care offense.
What are the Federal Laws Against Medicare Fraud?
18 U.S. Code § 1347 provides the federal laws against healthcare fraud and abuse, including Medicare. Under this section, it is unlawful for any person to knowingly and willingly:
Execute a scheme with the intent of defrauding any health care benefit program; or
Utilize fraudulent pretenses to obtain money or property owned by any health care benefit program.
As explained in the previous section, Medicare is a federal health care benefit program. Thus, any violation of Section 1347 would qualify as Medicare fraud under federal law.
That being said, there are several important considerations in this context. First, Section 1347 does not require actual knowledge or specific intent for violations. In other words, it is possible to commit health care fraud, even without knowing that the actions in question are illegal.
Second, U.S. federal law treats attempts and conspiracies in the same way as completed crimes. This means that any person who attempts or conspires to commit Medicare fraud will face the same punishment as if they had completed the crime.
What is the Federal Punishment for Medicare Fraud?
Section 1347 also supplies the punishment for Medicare fraud. Under this section, conviction for a violation, attempt, or conspiracy subjects the offender to criminal fines and imprisonment for a maximum of 10 years
If the Medicare fraud offense involved severe physical injury, however, the punishment changes. In these cases, Medicare fraud is punishable by criminal fines and imprisonment for a maximum of 20 years.
Finally, if the Medicare fraud offense involved a fatality, the penalties become more severe. In these situations, Medicare fraud is punishable by criminal fines and a maximum sentence of life in prison.
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