Penalties for Healthcare Fraud Convictions (and how to avoid them)

Healthcare fraud is a serious offense that carries significant legal consequences at both the state and federal levels. Convictions for healthcare fraud can result in severe penalties, including fines, imprisonment, restitution, and exclusion from federal healthcare programs. If you are under investigation or facing charges for healthcare fraud, it is critical to understand the potential penalties and seek skilled legal representation to protect your rights. For skilled legal representation defending against healthcare fraud charges in California, contact The Law Offices of Stanley L. Friedman to speak with a skilled and experienced Los Angeles healthcare fraud criminal defense attorney.

What Constitutes Healthcare Fraud?

Healthcare fraud encompasses a wide range of fraudulent activities, including:

• Billing for services not provided (phantom billing)
• Upcoding or unbundling of services
• Submitting false claims to Medicare, Medicaid, or private insurers
• Receiving or offering kickbacks in exchange for patient referrals
• Falsifying medical records or prescriptions
• Engaging in fraudulent billing schemes through telemedicine or durable medical equipment (DME)

Because healthcare fraud often involves federal programs such as Medicare and Medicaid, many cases are prosecuted under federal law, including the False Claims Act (FCA), the Anti-Kickback Statute (AKS), and the Health Care Fraud Statute (18 U.S.C. §1347).

Criminal Penalties for Healthcare Fraud Convictions

The penalties for healthcare fraud depend on factors such as the severity of the offense, the amount of money involved, and whether the fraud was intentional. Common criminal penalties include:

Imprisonment

• Under 18 U.S.C. §1347, individuals convicted of healthcare fraud may face up to 10 years in federal prison for each offense.
• If the fraud results in serious bodily injury, the sentence can increase to 20 years.
• If the fraud results in a patient’s death, a life sentence may be imposed.

Fines

• Individuals and entities convicted of healthcare fraud can be subject to substantial fines.
• Under the False Claims Act, penalties can include fines of up to $25,000 per false claim.
• Civil monetary penalties under the FCA can range from $13,000 to over $27,000 per false claim, plus treble (triple) damages.
• Violations of the Anti-Kickback Statute can lead to fines of up to $100,000 per violation.

Restitution and Asset Forfeiture

• Courts often order convicted individuals to pay restitution, which requires them to reimburse the government or insurers for fraudulent claims.
• Asset forfeiture may also apply, meaning that property or funds obtained through fraudulent activities can be seized by the government.

Civil Penalties and Administrative Consequences

Beyond criminal penalties, individuals and entities convicted of healthcare fraud may also face civil and administrative repercussions, including:

Exclusion from Federal Healthcare Programs

• A conviction for healthcare fraud can result in exclusion from Medicare, Medicaid, and other federally funded healthcare programs, often effectively ending a medical provider’s career.
• The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) has the authority to impose mandatory or permissive exclusions depending on the nature of the offense.

Civil Liability Under the False Claims Act

• Healthcare providers, hospitals, and other entities may be held liable under the False Claims Act (FCA) even if they were not criminally convicted.
• Whistleblower lawsuits (qui tam actions) can be filed under the FCA, allowing private individuals to report fraudulent activity and receive a portion of the recovered funds.

Defending Against Healthcare Fraud Charges

Given the severe penalties associated with healthcare fraud convictions, individuals accused of these offenses must act quickly to mount a strong defense. Potential defenses include:

• Lack of intent – Demonstrating that any errors were due to negligence rather than intentional fraud.
• Insufficient evidence – Challenging the prosecution’s case by highlighting weaknesses in the evidence.
• Regulatory compliance – Showing that the alleged actions were consistent with industry standards and legal guidelines.
• Constitutional violations – Arguing that evidence was obtained unlawfully in violation of the Fourth or Fifth Amendments.

Contact a Skilled California Healthcare Fraud Defense Attorney for Immediate Assistance

If you or your organization is facing healthcare fraud charges in California, the consequences could be life-altering. The Law Offices of Stanley L. Friedman specializes in defending individuals and businesses accused of white-collar crimes, with a focus on healthcare fraud. With extensive experience handling complex federal and state fraud cases, we work tirelessly to protect our clients’ rights and reputations.

Don’t face healthcare fraud charges alone—contact The Law Offices of Stanley L. Friedman in Beverly Hills today for a confidential consultation and aggressive legal representation.