Healthcare fraud is a serious criminal offense and the Health Insurance Portability and Accountability Act of 1996 makes an attempt to abuse or manipulate insurers or state or federal government healthcare programs for profit a federal crime.

The crime of federal healthcare fraud is punishable by a prison sentence of up to 10 years and considerable fines, in addition to a number of secondary consequences that may result from a fraud conviction, possibly including job loss, the loss of professional licensing, and a permanent criminal record.

Medicare fraud, Medicaid fraud, billing fraud, and illegal kickback schemes occur all too frequently in the healthcare field, and allegations of fraud require immediate intervention by a criminal defense attorney with extensive experience in federal court. If you have been arrested for or charged with healthcare fraud, don’t leave your future in the hands of an amateur.

Contact our federal healthcare fraud defense lawyers at Seyb Law Group today to discuss your legal defense.


Healthcare fraud cases are complex and nuanced and if you are facing charges of federal healthcare fraud, you should only trust your defense to an attorney who has experience with the federal criminal justice system.

Federal criminal cases differ a great deal from state cases, and for federal healthcare fraud charges, you’ll want an attorney in your corner who is not only familiar with federal law and the federal court system but one who understands the healthcare system and has a proven history of success in defending allegations of healthcare fraud.

Our defense attorneys at Seyb Law Group have more than 60 years of combined criminal defense experience, and we are committed to protecting the rights of those falsely accused of serious federal offenses, like healthcare fraud and Medicare fraud.

We represent physicians, nurse practitioners, hospitals, therapists, and individual members of healthcare plans facing criminal charges for healthcare fraud, and we have a proven track record of success at trial.

At Seyb Law Group, we have represented clients in all manner of criminal cases, and we understand how severely a healthcare fraud conviction would affect you and your family.

We also recognize the fact that all healthcare fraud cases are different, with unique circumstances that can influence prosecution and sentencing, and we give each case the personalized attention it deserves, from the moment we are hired to the conclusion of the case.

Our top priority in defending you against healthcare fraud allegations is to help you get the best possible outcome in your case, whether that means negotiating with the prosecution for a favorable plea deal, securing a reduction in charges to minimize the penalties for conviction, or possibly even getting the charges dismissed altogether.

Whatever kind of healthcare fraud allegations you are facing, our criminal defense attorneys are prepared to guide you through the process of defending yourself in court and ensuring your legal rights are protected. Consult our lawyers as soon as possible for a free evaluation of your federal healthcare fraud case.


Healthcare fraud is a broad crime that typically involves making false or fraudulent claims to access something of value, usually money, and being accused of healthcare fraud can mean different things for different people.

While the majority of healthcare fraud cases in the United States involve allegations against healthcare providers and medical institutions accused of overbilling for services or falsifying patient records, among other potentially illegal acts, patients can also be accused of defrauding the healthcare system for profit.

This may include forging a prescription for medication or submitting a false claim to an insurance company. In some cases, even unintentional billing errors and other innocent mistakes can lead to federal charges, if the federal government suspects a fraudulent scheme.

Some common types of healthcare fraud possibly leading to criminal charges being filed in federal court include the following:

Healthcare fraud by providers:

  • Overbilling for services
  • Billing for services or tests not rendered
  • Receiving compensation from a company whose medical products the provider uses or prescribes (kickbacks and bribes)
  • Making false or fraudulent claims
  • Using false billing codes
  • Submitting duplicate claims
  • Referring patients to a facility in which the referring physician has a hidden financial interest (physician self-referrals)
  • Committing prescription drug fraud
  • Billing for medically unnecessary services, equipment or supplies
  • Billing for services, equipment or supplies that were not provided
  • Inaccurately reporting test results
  • Falsifying patient medical records
  • Submitting false information on applications for medical services

Healthcare fraud by patients:

  • Submitting false insurance claims
  • Receiving medical care under someone else’s insurance plan, or allowing someone else to use your insurance card
  • Faking a medical condition to obtain covered prescriptions to then sell
  • Obtaining healthcare coverage by providing false information
  • Forging prescriptions

Federal Healthcare Fraud 18 U.S.C. § 1347

The federal government has a number of tools at its disposal to prosecute individuals and providers suspected of defrauding Medicare, Medicaid, and other healthcare benefit programs, the most powerful being Section 1347 of Title 18, United States Code. The acts prohibited by 18 U.S.C. § 1347 are extraordinarily broad and the penalties associated with a violation of this federal statute are severe.

The law states:

(a) Whoever knowingly and willfully executes, or attempts to execute, a scheme or artifice—

  1. to defraud any health care benefit program; or
  2. to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program,

in connection with the delivery of or payment for health care benefits, items, or services, shall be fined under this title or imprisoned not more than 10 years, or both. If the violation results in serious bodily injury (as defined in section 1365 of this title), such person shall be fined under this title or imprisoned not more than 20 years, or both; and if the violation results in death, such person shall be fined under this title, or imprisoned for any term of years or for life, or both.

(b) With respect to violations of this section, a person need not have actual knowledge of this section or specific intent to commit a violation of this section.

Under 18 U.S.C. § 1347, an individual patient or healthcare provider can be held criminally liable for intentionally defrauding any healthcare benefit program or using false statements to obtain funds from a federal healthcare program.


Individual states have implemented their own laws regulating the healthcare system, but healthcare fraud of any variety is a federal offense, and fraud cases can therefore be tried at the federal level.

The federal government has taken a strong stance against Medicare fraud and other types of illegal healthcare fraud, and these cases tend to be thoroughly investigated by the FBI and the U.S. Department of Health and Human Services and heavily prosecuted by the U.S. Attorney’s Office.

In a “standard” case of healthcare fraud, a medical provider charged under 18 U.S.C. § 1347 faces fines of up to $250,000 (for an individual) or $500,000 (for an organization), and imprisonment in federal prison for up to 10 years.

If the healthcare fraud results in bodily injury (i.e. a patient overdoses on a prescribed drug that was not medically necessary), the penalty can increase to 20 years in federal prison.

If the fraud results in death (i.e. the overdose is fatal), a violation of 18 U.S.C. § 1347 can carry a life sentence in federal prison.


Getting a grasp on the severity of the healthcare fraud charges you are facing means understanding the key elements of the crime.

In order to be found guilty of healthcare fraud under 18 U.S.C. § 1347, the law states that you must “knowingly and willfully execute” a fraudulent scheme.

However, to get a criminal conviction for healthcare fraud, the prosecution does not have to prove that you specifically intended to violate 18 U.S.C. § 1347 by defrauding a healthcare program.

If he or she can prove that you were aware, or were willfully ignorant of the fact, that you were involved in a fraudulent scheme, this may be enough to convict you of healthcare fraud.

Facing federal healthcare fraud charges in federal court may seem like the end of your life as you know it.

However, it is important to remember that an arrest is not the same thing as a conviction.

The crime of healthcare fraud is never presumed, and the burden of proof is always on the federal government to prove that you committed the alleged fraud beyond a reasonable doubt.

Best Defense Strategies in Federal Healthcare Fraud Cases

The term healthcare fraud broadly covers any act of abusing or manipulating or attempting to abuse or manipulate, an insurer or healthcare program for profit, and this federal crime can be committed by healthcare providers or individual members of a healthcare plan.

However, just because you are under investigation for healthcare fraud does not mean you will be found guilty of any wrongdoing.

There are a number of defenses your attorney can present on your behalf to fight healthcare fraud charges and challenge the federal prosecutor’s case against you, including the following:

  • You did not intend to commit healthcare fraud
  • There isn’t enough evidence to warrant healthcare fraud charges
  • You were compelled or pressured to commit healthcare fraud by a representative of the government (entrapment)
  • Your alleged actions do not constitute healthcare fraud


Healthcare fraud remains a key concern of the federal government and the U.S. Department of Justice will continue to target individual patients, physicians and healthcare companies suspected of defrauding insurers and government healthcare programs.

For minor offenses, the government may decide to invoke only civil penalties, such as restitution for the amount unlawfully obtained by fraud, but the majority of healthcare fraud cases will be tried at the criminal level and punished according to the severity of the crime.

Any time you are facing federal charges for healthcare fraud, you need a defense attorney on your side who won’t back down from federal prosecutors, one who will act swiftly and strategically to protect your rights and your best interests.

Allegations of healthcare fraud can affect virtually any individual or healthcare company accused of violating a federal statute, and a conviction for fraud can result in a federal prison sentence of up to 10 years per count, plus fines of up to half a million dollars, or twice the amount of the fraud, for even the most “standard” criminal offenses.

Our lawyers at Seyb Law Group represent healthcare providers and individuals in healthcare fraud cases and we will use every resource at our disposal to help you get the best possible outcome in your criminal case.

Our legal team will fight for your rights throughout the criminal court process, investigating every aspect of your case, challenging the prosecution’s evidence, and, if necessary, representing you in court and at trial.


Healthcare fraud is prosecuted harshly in the United States, and while the majority of healthcare fraud cases involve allegations against medical providers who manipulate insurers or defraud the healthcare system for profit, patients can also commit healthcare fraud, either intentionally or unintentionally, and may face federal charges as a result.

In addition to the immediate consequences of a criminal conviction, being found guilty of healthcare fraud will also leave you with a permanent criminal record, which can adversely affect nearly every aspect of your life, including your personal relationships, your professional reputation, and even your career.

If you believe you may be the target of a federal healthcare fraud investigation, or if you have been charged with Medicare fraud, Medicaid fraud, or another type of healthcare fraud, do not leave your future up to chance.

Contact our Orange County criminal defense attorneys at Seyb Law Group today for legal help.

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