Federal Healthcare Fraud Charges Under 18 USC 1347: When Billing Becomes Criminal
So your probably facing federal healthcare fraud charges and your ABSOLUTELY TERRIFIED because you thought billing issues were civil matters. Maybe there’s allegations you submitted false claims to Medicare. Maybe prosecutors claim you received kickbacks for patient referrals. Or maybe your just accused of “upcoding” or billing for services that weren’t medically necessary. Look, we get it. Your COMPLETELY OVERWHELMED by these charges. And you should be! Because healthcare fraud under 18 USC 1347 carries 10 YEARS in federal prison (or life if someone dies) and prosecutors treat healthcare fraud as top priority generating billions in settlements annually!
What Is Federal Healthcare Fraud Under 18 USC 1347?
Let me explain the prosecutorial weapon destroying medical practices. Section 1347 enacted in 1996 and criminalizes knowingly executing scheme to defraud healthcare benefit program or obtain money by false pretenses! Applies to Medicare, Medicaid, TRICARE, and ALL federal healthcare programs!
The statute requires TWO elements: (1) knowingly executed or attempted to execute scheme to defraud healthcare benefit program, (2) with intent to defraud! Prosecutors don’t need to prove actual loss to government – attempted fraud is same crime! Claim denied but you submitted it? Still 10 years!
Here’s what’s really scary – EACH false claim is separate count! Submitted 100 Medicare claims prosecutors say were fraudulent? That’s 100 healthcare fraud counts! Each carrying 10 years! We’ve seen indictments with 500+ counts from routine medical billing!
Penalties ESCALATE if harm results! Serious bodily injury increases maximum to 20 years! Death increases to life imprisonment! Prescribed unnecessary opioids and patient overdosed? LIFE! Performed medically unnecessary surgery with complications? 20 years!
What Are the Key Healthcare Fraud Laws?
Multiple overlapping statutes create minefield for healthcare providers!
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(212) 300-5196Section 1347 is primary healthcare fraud statute! But prosecutors also charge False Claims Act, Anti-Kickback Statute, and Stark Law violations! Five major federal fraud and abuse laws apply to physicians and healthcare providers!
False Claims Act (31 USC 3729-3733) is civil statute with criminal penalties! Filing false claims may result in fines up to three times government’s loss PLUS $11,000 per claim! One claim with minor error? $11,000 penalty! 1,000 claims? $11 MILLION!
Anti-Kickback Statute (42 USC 1320a-7b) prohibits paying or receiving remuneration for patient referrals! Criminal penalties include 10 years prison and $100,000 fine! PLUS civil penalties of $50,000 per violation plus 3X remuneration amount!
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You are a physician who received a target letter from the U.S. Attorney's Office stating you are under investigation for submitting over $2.3 million in false claims to Medicare for physical therapy services that were either never provided or not medically necessary. Federal agents have already interviewed several of your former billing staff and obtained your practice's electronic health records through a grand jury subpoena.
Can I really face federal prison time over what I believed were legitimate billing disagreements with Medicare?
Under 18 USC 1347, healthcare fraud carries penalties of up to 10 years in federal prison per count, and if any patient suffered serious bodily injury as a result, that maximum jumps to 20 years. Prosecutors do not need to prove you had expert knowledge of billing codes — they only need to show you knowingly and willfully executed, or attempted to execute, a scheme to defraud a healthcare benefit program. The distinction between a civil billing dispute and criminal fraud often comes down to intent, which is why your communications, internal records, and any pattern of systematic upcoding become critical evidence. You need a federal defense attorney immediately, before you make any statements or respond to that target letter, because anything you say now — even to your own staff — can be used to establish the intent element the government needs to secure a conviction.
This is general information only. Contact us for advice specific to your situation.
Stark Law (42 USC 1395nn) prohibits physician self-referrals for designated health services! Civil statute only – no criminal penalties! But violations can be $15,000 per service plus exclusion from Medicare! Stark Law is strict liability – don’t need intent to violate!
Prosecutors charge ALL statutes for same conduct! One kickback arrangement? Healthcare fraud (1347), Anti-Kickback Statute, False Claims Act, wire fraud, mail fraud! Five federal felonies for one arrangement!
