Federal Health Care Fraud Lawyer – 18 U.S.C. § 1347
Federal health care fraud allegations are among the most aggressively prosecuted white-collar crimes in the United States.
Under 18 U.S.C. § 1347, prosecutors pursue doctors, nurses, clinic owners, executives, billing companies, and other health care professionals accused of defrauding health care benefit programs such as Medicare, Medicaid, TRICARE, Medi-Cal, or private insurers.
A conviction can result in years or even life in federal prison, massive fines, mandatory restitution, permanent exclusion from federal health programs, and the loss of professional licenses.
These cases are complex, evidence-heavy, and often investigated long before charges are filed.
The healthcare civil investigative demand (CID) is one of the most powerful pre-litigation tools employed by the United States Department of Justice (DOJ).
If you are under investigation or have been charged with federal health care fraud, early intervention by an experienced federal criminal defense attorney is critical.
Eisner Gorin LLP defends health care professionals and organizations facing serious federal fraud allegations throughout California and nationwide. Schedule your consultation at (818) 781-1570 or contact us here.
What Is Federal Health Care Fraud Under 18 U.S.C. § 1347?
18 U.S.C. § 1347 makes it a federal crime to knowingly and willfully execute—or attempt to execute—a scheme to:
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Defraud a health care benefit program, or
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Obtain money or property owned by or under the control of a health care benefit program through false or fraudulent pretenses, representations, or promises
In simple terms, the statute criminalizes intentional deception used to obtain money or services from a health care program that the defendant knew they were not entitled to receive.
Medical upcoding happens when healthcare providers submit exaggerated insurance billing codes to secure higher reimbursements. Federal prosecutors often accuse this practice of being health care fraud under 18 U.S.C. § 1347.
The Critical Element: Intent to Defraud
As with most fraud offenses, the intent to defraud is the central issue in any § 1347 case.
Prosecutors must prove that the defendant:
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Acted knowingly and willfully, and
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Intended to deceive a health care program to obtain money or services
The government need not prove that the defendant knew their conduct violated federal law. If the defendant knew the statements or representations were false and used them to obtain benefits, that is sufficient for conviction.
Defrauding a Federal or State Health Care Program
Health care fraud cases commonly involve federal programs, including:
Example: Eligibility Fraud
Many health care benefit programs are subject to means testing, meaning eligibility depends on income or other financial criteria.
If a defendant knowingly misrepresents income or eligibility information to qualify for benefits—and then receives subsidized care or payments—that conduct may constitute federal health care fraud under § 1347.
Who Is Commonly Charged With Health Care Fraud?
Federal health care fraud prosecutions often target:
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Nurses and nurse practitioners
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Physical therapists
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Clinic owners and administrators
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Billing and coding companies
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Executives of health care organizations
According to federal law enforcement agencies, health care fraud costs the United States tens of billions of dollars annually, making it a top enforcement priority.
Common Types of Health Care Fraud Allegations
Health care fraud can take many forms. Common allegations include:
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Billing for services not rendered
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Billing for medically unnecessary services
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Upcoding services or equipment
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Duplicate or double-billing
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Excessive or inflated services
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Falsifying patient records
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Prescription fraud
California dentists could face criminal charges under Penal Code 550 PC for actions that may appear to be routine practice management on the surface.
Even alleged billing “errors” may be charged as fraud if prosecutors believe they show a pattern of intent.
Health Care Fraud Conspiracy – 18 U.S.C. § 1349
Federal prosecutors frequently charge health care fraud as a conspiracy under 18 U.S.C. § 1349.
A conspiracy charge requires:
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An agreement to commit health care fraud, and
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Knowing participation in that agreement
No completed fraud is required—agreement alone can support a conviction.
Example of a Fraud Conspiracy
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Recruiters (“cappers”) bring patients to a clinic
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Patients receive kickbacks
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The clinic bills a federal program for services not provided
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All participants—including recruiters and patients—may be charged
Penalties for conspiracy are the same as the underlying fraud, including up to life imprisonment if injury or death results.
Other Federal Laws Commonly Used in Health Care Fraud Cases
Health care fraud investigations often involve multiple overlapping statutes, including:
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The Stark Law
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Civil Monetary Penalties Law
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Exclusion statutes enforced by the Office of Inspector General
Federal prosecutors often stack charges to increase leverage and sentencing exposure.
Penalties for Federal Health Care Fraud
A conviction under 18 U.S.C. § 1347 carries severe consequences:
Criminal Penalties
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Up to 10 years in federal prison
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Up to 20 years if serious bodily injury results
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Life imprisonment if death results
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Substantial fines
Collateral Consequences
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Permanent loss of medical or professional licenses
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Exclusion from Medicare and Medicaid
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Restitution and asset forfeiture
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Long-term employment and reputational harm
These collateral consequences often devastate careers even after incarceration ends.
The Importance of Early Legal Representation
Most health care fraud cases are built during the investigation phase, long before an indictment is filed. Many defendants make the mistake of waiting until charges are filed before retaining counsel.
An experienced federal defense attorney can:
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Intervene during the investigation
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Communicate with prosecutors and agents
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Prevent damaging statements
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Seek pre-indictment resolutions
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Develop defenses before charges escalate
Early legal action can significantly alter the outcome of a case.
Defending Federal Health Care Fraud Charges
A charge is not a conviction. Effective defense strategies may include:
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Lack of intent to defraud
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Good-faith billing practices
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Regulatory complexity or ambiguity
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Reliance on billing specialists or consultants
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Insufficient evidence
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Constitutional or procedural violations
Each case requires a detailed analysis of billing records, communications, and regulatory requirements.
Speak With a Federal Health Care Fraud Defense Lawyer
If you or a loved one is under investigation or facing charges for federal health care fraud under 18 U.S.C. § 1347 or § 1349, do not wait.
Early legal guidance can protect your freedom, your license, and your future.
Contact Eisner Gorin LLP, based in Los Angeles, California, for a confidential consultation.
📞 Call (818) 781-1570 to begin building your defense strategy today, or contact us here.
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