Health Care Fraud


Health care fraud cases are complex, and require a savvy litigator to ensure that your rights are protected. Health care fraud cases frequently involve hundreds of thousands, if not millions of dollars of losses, which can result in a lengthy term of imprisonment unless avoided through proper trial advocacy and/or sentence mitigation strategies.

Are you or a loved one facing health care fraud charges brought by the federal government? If so, contact us today.


Health care fraud is a federal crime under 18 U.S.C. § 1347. It is a “white collar” crime that happens when a health practitioner or a consumer intentionally submits fake or misleading information that is used to determine how much of a health care benefit should be paid.

What Are Activities That Are Considered Fraud?

Some, but not all, of the most common types of health care fraud committed by PROVIDERS includes:

  • Billing for a service that was not performed
  • Misreporting ambulatory transport trips or mileage
  • Faking a diagnosis to provide justification to perform unnecessary tests or procedures
  • Misrepresenting procedures that are performed in order to receive payment for services that are not covered (such as cosmetic surgery)
  • Billing for a service that costs more than the one that was performed (aka: ‘upcoding’)
  • Billing for each stage of a complete procedure in order to drive up the cost (aka: ‘unbundling’)
  • Accepting a kickback for a patient referral
  • Waiving copays or deductibles
  • Billing patients higher amounts than the copay requires
Some, but not all, of the most common types of health care fraud committed by CONSUMERS  includes:
  • Filing a claim for a service that was not received
  • Filing a claim for a medication that was not received
  • Altering a bill or receipt
  • Using another persons’ insurance card to receive services

Penalties for Health Care Fraud

It is a serious matter to commit health care fraud, and federal criminal health care fraud charges can lead to serious consequences for anyone convicted.
  • Prison – A conviction for federal health care fraud can result in a 10-year sentence for each offense. If the health care fraud results in serious bodily injury to someone, there is a potential sentence of up to 20 years in prison, and an act of health care fraud that results in someones death has the potential for a life sentence.
  • Fines – Fines for health care fraud can range from $250,000 to more than $1 million, or even into the billions of dollars.
  • Restitution – As part of a criminal health care fraud sentence, a judge can order defendants to pay back the amount of money that was obtained as a result of their fraudulent acts. This is in addition to any fines imposed.
  • Probation – Anyone convicted of a health care fraud crime also faces the possibility of a probation sentence. Probation limits the amount of freedom a person has instead of sending them to prison. Probation can last 12 months through many years. Those of probation must comply with certain specific conditions, including the possibility of regular meetings with a probation officer, staying employed, not associating with known felons, and other stipulations. Violating any of these conditions can result in probation being revoked and a person having to serve the rest of their time in prison.

Defenses in Health Care Fraud Cases

  • Health Care Fraud Statute – A primary element that must be proven under this statute is the intent to defraud a health care benefit program. If a person lacks specific intent to defraud a health care benefit program, the government may be unable to demonstrate health care fraud.
  • Antikickback Statute – A common defense to health care fraud charges under the Antikickback Statute involves demonstrating that the business transaction fell under the safe harbor provisions of the statute. The safe harbor provisions protect (among other transactions) investment interests, referral services, relationships between providers, arrangements between providers and health plans, and relationships between providers and suppliers.
  • Stark Law – The Stark Law contains a number of exceptions for potential physician self-referral situations. These exceptions include personal services, bona fide employment relationships, physician recruitment, and physicians practicing in rural areas and locations designated as Health Professional Shortage Areas.
Have you or a loved one been charged with or convicted of a federal crime? You need an experienced Federal Defense Lawyer who can help fight for your freedom. Because we are good at what we do, we have clients from all over the country to count on us to provide them with competent and reasonably priced services. Contact us today for a free consultation.

The Law Office of Jeremy Gordon has been practicing federal criminal appeals and post-conviction law since 2012. We have had favorable outcomes in more than 70 cases in the past four years. Our entire staff is committed to providing excellent service to our clients and their families. We encourage you to contact our office today to visit with us on how we might be able to help you or your loved one get the representation they deserve. You can also add us on Facebook or Twitter

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