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What is federal health care fraud?

On Behalf of | Sep 28, 2021 | Criminal Defense |

Fraud of any kind on the federal level is a serious crime that has severe consequences for those who get entangled in it. South Carolina residents who have been accused of fraud in the health care sector need to know the laws surrounding this offense.

With federal health care fraud, the main perpetrators of the offense are doctors and medical providers. It’s a crime that can be committed by anyone who receives unlawful payments or benefits by intentionally deceiving the health care system.

Those who commit federal health care fraud are usually investigated by the FBI. This is the main agency that deals with this type of criminal law with insurance programs both private and federal.

The elements of health care fraud

One of the key elements of fraud is that it has to have been done “knowingly and willfully.” This detail is what many criminal cases hinge on.

It’s important to note that the person doesn’t have to know about the details of the law or have specific intentions of breaking it in order to be charged. The offense must include, however, a knowing and willing attempt, be it successful or not, at defrauding a health care benefit program or obtaining money or property from such a program under false pretenses. Individuals who can prove that their fraudulent activity was unintentional or done without their knowledge, such as if another person stole their identity to commit the fraud, may be able to get the charges dismissed or reduced.

Federal health care fraud comes with serious consequences for those who get convicted in a court of law. For anyone who has been accused of this type of fraud, developing a strong defense may help prevent a conviction and the associated penalties.