Federal Crime of Medicaid Fraud – 18 U.S.C. § 1347

What Is Medicaid Fraud Under 18 U.S.C. § 1347?

Medicaid fraud is a federal healthcare fraud offense prosecuted under 18 U.S.C. § 1347. The statute makes it illegal to knowingly and willfully execute, or attempt to execute, a scheme to:

Defraud any healthcare benefit program, or
Obtain money or property from a healthcare benefit program through false or fraudulent pretenses

Medicaid fraud involves the theft of government funds through false billing, fabricated services, inflated claims, kickbacks, or misrepresentations related to healthcare treatment.

Federal prosecutors aggressively pursue these cases, especially when large financial losses or coordinated schemes are involved.

Your best chance for a favorable outcome is with an experienced criminal defense attorney at the Hedding Law Firm in Los Angeles. To schedule a consultation, call (866) 986-2092 or use the contact form here.

Common Examples of Medicaid Fraud

Medicaid fraud investigations often involve allegations such as:

Billing for services never provided
Submitting false time sheets
Charging for face-to-face visits that never occurred
Billing for physician services without licensed physicians on staff
Upcoding procedures to receive higher reimbursement
Paying or receiving illegal kickbacks

Federal agencies frequently target providers, billing companies, administrators, and even professionals who allegedly assist in fraudulent schemes.

What Must the Government Prove in a Medicaid Fraud Case?

To secure a conviction under 18 U.S.C. § 1347, the government must prove beyond a reasonable doubt:

The defendant knowingly executed or attempted to execute a scheme
The scheme was intended to defraud a healthcare benefit program
The defendant acted with the intent to deceive

Intent is often the central issue. Mistakes, billing errors, or regulatory confusion are not automatically criminal.

Penalties for Medicaid Fraud

A conviction under 18 U.S.C. § 1347 carries:

Up to 10 years in federal prison
Up to 20 years if serious bodily injury results
Substantial fines
Restitution
Federal forfeiture
Exclusion from federal healthcare programs

In some cases, defendants also face civil liability under the False Claims Act in addition to criminal prosecution.

When Do Federal Authorities Get Involved?

Large-scale investigations typically involve agencies such as:

Federal Bureau of Investigation
U.S. Department of Homeland Security
U.S. Department of Health and Human Services
United States Secret Service

Federal healthcare fraud investigations often include:

Wiretaps
Search warrants
Grand jury subpoenas
Cooperating witnesses
Financial tracing

It is common for the government to build cases using insiders who agree to cooperate in exchange for reduced exposure.

Medicare Fraud vs. Medicaid Fraud

Although closely related, Medicare fraud involves federal billing related to Medicare benefits, while Medicaid fraud typically involves joint federal-state programs.

What Is Medicare Fraud?

Medicare fraud generally occurs when healthcare providers bill for:

Services that were not medically necessary
Services never provided
Supplies not delivered
Inflated or duplicated claims

Facilities frequently involved in investigations include:

Hospitals
Nursing homes
Residential care facilities
Outpatient clinics

Like Medicaid fraud, Medicare fraud requires proof of intentional deception.

What Should You Do If You Are Under Investigation?

If you learn that federal agents are investigating you:

Do not speak to investigators without counsel
Do not destroy records
Preserve all billing and compliance documentation
Immediately consult a federal criminal defense attorney

Healthcare fraud investigations can take months or years before charges are filed. Early intervention can significantly impact outcomes.

Possible Defenses to Medicaid Fraud Charges

Every case is fact-specific. Common defenses include:

Lack of intent
Good faith reliance on billing staff
Regulatory ambiguity
Insufficient evidence of a scheme
Improper investigative procedures

In many cases, the government's narrative may rely heavily on cooperating witnesses who have their own motives.

Why Early Legal Strategy Matters

Federal prosecutors often build complex financial cases before an arrest occurs. By the time charges are filed, the government may have:

Financial audits
Recorded communications
Insider testimony
Document seizures

Early legal representation allows counsel to:

Analyze exposure
Assess cooperation risks
Evaluate potential defenses
Begin negotiations where appropriate
Position the case for the best possible resolution

Frequently Asked Questions

Is Medicaid fraud a felony?

Yes. Medicaid fraud under 18 U.S.C. § 1347 is a federal felony offense.

Can billing errors result in criminal charges?

Simple billing mistakes are not automatically criminal. Prosecutors must prove intent to defraud.

What is the statute of limitations?

Healthcare fraud cases generally carry a six-year statute of limitations, though related charges may extend exposure.

Can professionals lose their licenses?

Yes. Convictions often result in exclusion from federal programs and professional licensing consequences.

Speak With a Federal Criminal Defense Lawyer

Healthcare fraud allegations threaten your freedom, professional license, and reputation. If you are facing an investigation or indictment involving Medicaid or Medicare fraud, immediate legal guidance is critical.

An experienced federal criminal defense attorney can assess your exposure, analyze the government's evidence, and develop a strategic defense designed to protect your future.

The Hedding Law Firm is here to help. Schedule your consultation today. Our law firm is based in Los Angeles, CA

Related Articles

Medicaid Fraud