Federal Health Care Fraud
18 U.S.C. § 1347 Defense Lawyer
Federal health care fraud charges under 18 U.S.C. § 1347 are among the most aggressively prosecuted white-collar crimes in the United States.
The federal government devotes significant resources to investigating and prosecuting alleged fraud involving Medicare, Medicaid, TRICARE, and private insurance plans that receive federal funding.
If you are under investigation—or have already been charged—with federal health care fraud, your freedom, professional license, reputation, and financial future are at stake. These cases are not routine.
They involve complex billing systems, extensive records, federal agencies, and prosecutors who rarely file charges unless they believe they can win.
Early intervention by an experienced federal criminal defense attorney is critical. The Hedding Law Firm is here to help. Schedule your consultation at (866) 986-2092 or contact us here.
What Is Federal Health Care Fraud Under 18 U.S.C. § 1347?
Under 18 U.S.C. § 1347, a person commits health care fraud if they knowingly and willfully execute, or attempt to execute, a scheme to defraud a health care benefit program or to obtain money or property by false or fraudulent representations related to health care services.
The statute applies to both health care providers and consumers.
To obtain a conviction, federal prosecutors must prove beyond a reasonable doubt that:
-
A health care benefit program existed
-
The defendant knowingly executed or attempted to execute a fraudulent scheme
-
The scheme involved false or misleading representations
-
The defendant acted willfully and with the intent to defraud
Mistakes, billing errors, or differences in interpretation do not automatically constitute fraud. Intent is a critical element.
Who Can Be Charged With Health Care Fraud?
Federal health care fraud charges can apply to a wide range of individuals, including:
-
Doctors and physicians
-
Nurses and medical assistants
-
Chiropractors and therapists
-
Pharmacists and pharmacy owners
-
Medical billing companies
-
Durable medical equipment (DME) suppliers
-
Clinic owners and office managers
-
Patients and insurance beneficiaries
Both providers and consumers can face prosecution.
Common Examples of Health Care Fraud Allegations
Federal prosecutors frequently allege health care fraud based on accusations such as:
Provider-Related Allegations
-
Billing for services never performed
-
Billing for medically unnecessary procedures
-
Submitting claims for non-covered services
-
Double-billing or billing beyond co-pay amounts
-
Paying or receiving illegal kickbacks
Consumer-Related Allegations
-
Using another person's insurance
-
Submitting false claims for treatment or medication
-
Forging or altering medical bills or receipts
-
Doctor shopping for prescription drugs
Federal investigators often rely on billing patterns, not direct proof, to initiate cases.
Federal Agencies That Investigate Health Care Fraud
Health care fraud cases are typically investigated by multiple federal agencies, including:
-
FBI
-
Department of Health and Human Services Office of Inspector General (HHS-OIG)
-
Centers for Medicare & Medicaid Services (CMS)
-
DEA (when prescriptions are involved)
-
IRS Criminal Investigation (financial aspects)
These agencies have the authority to conduct search warrants, surveillance, subpoenas, and asset seizures.
Penalties for Federal Health Care Fraud
A conviction under 18 U.S.C. § 1347 carries severe penalties:
-
Up to 10 years in federal prison per count
-
Up to 20 years if the violation results in serious bodily injury
-
Life imprisonment if death results
-
Substantial fines
-
Restitution for alleged losses
-
Forfeiture of assets
-
Loss of professional licenses
-
Exclusion from Medicare and Medicaid programs
Sentencing is often driven by loss calculations, which are frequently disputed and inflated by the government.
Common Defenses to Federal Health Care Fraud Charges
Every case is fact-specific, but effective defense strategies may include:
Lack of Intent
Health care fraud requires willful intent. Errors, negligence, or misunderstandings are not crimes.
Good-Faith Billing Practices
Demonstrating reliance on billing staff, coders, or industry standards can defeat intent.
Insufficient Evidence
The government often relies on data analytics rather than direct proof.
Selective or Overzealous Prosecution
Some cases involve aggressive enforcement rather than actual fraud.
Statute of Limitations
Federal fraud cases are subject to time limits.
Constitutional Violations
Illegal searches, seizures, or improperly obtained evidence may be suppressed.
Loss Amount Challenges
Reducing alleged loss amounts can dramatically reduce sentencing exposure.
The Importance of Early Legal Representation
One of the biggest mistakes people make in health care fraud cases is talking to federal agents without a lawyer.
Federal agents are trained investigators. They are not there to help you explain your side of the story. Anything you say can and will be used against you.
Another common mistake is doing nothing—hoping the investigation will go away. Inactivity often allows the government to build a stronger case.
A defense attorney can:
-
Intervene before charges are filed
-
Communicate with prosecutors on your behalf
-
Prevent damaging statements
-
Conduct an independent investigation
-
Negotiate pre-indictment resolutions
-
Develop a strategy tailored to your situation
Negotiation vs. Trial in Health Care Fraud Cases
Some health care fraud cases can be resolved through negotiation. Others must be fought aggressively.
A seasoned federal defense attorney will evaluate:
-
The strength of the government's evidence
-
The risk of trial
-
Potential sentencing exposure
-
Whether early cooperation is beneficial
-
Whether dismissal or reduction is possible
Not every case should go to trial—but not every case should be surrendered either.
Speak With a Federal Health Care Fraud Defense Lawyer
If you are under investigation or charged with federal health care fraud under 18 U.S.C. § 1347, the stakes could not be higher. Your professional life, freedom, and reputation are on the line.
An experienced federal criminal defense attorney can help you regain control, protect your rights, and pursue the best possible outcome.
Contact a federal health care fraud lawyer at the Hedding Law Firm in Los Angeles at 866-986-2092 to discuss your case confidentially and begin building your defense.
Related Content: