Health Care Fraud - Elements of the Offense (18 U.S.C. Sec. 1347) (revised 2015) Source: http://www.ca3.uscourts.gov/model-criminal-jury-table-contents-and-instructions
Health Care Fraud — Elements of the Offense (18 U.S.C. Sec. 1347) (revised 2015) is a federal law that prohibits individuals and organizations from knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program or to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the control of, any health care benefit program. This offense covers a variety of fraudulent activities, including billing for services or items that are not medically necessary, submitting claims for services that were not actually provided, submitting false or fraudulent cost reports, and submitting claims for services provided by unlicensed providers. There are two types of Health Care Fraud — Elements of the Offense (18 U.S.C. Sec. 1347) (revised 2015): (1) health care fraud for a federal health care benefit program; and (2) health care fraud not involving a federal health care benefit program. The first type of fraud covers activities related to federal health care programs, such as Medicare, Medicaid, TRI CARE, the Federal Employees Health Benefits Program (FEB), and the Veterans Health Administration (VA). The second type of fraud covers activities related to private health care benefit programs, such as private health insurance plans or employer-sponsored health care plans.
Health Care Fraud — Elements of the Offense (18 U.S.C. Sec. 1347) (revised 2015) is a federal law that prohibits individuals and organizations from knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program or to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the control of, any health care benefit program. This offense covers a variety of fraudulent activities, including billing for services or items that are not medically necessary, submitting claims for services that were not actually provided, submitting false or fraudulent cost reports, and submitting claims for services provided by unlicensed providers. There are two types of Health Care Fraud — Elements of the Offense (18 U.S.C. Sec. 1347) (revised 2015): (1) health care fraud for a federal health care benefit program; and (2) health care fraud not involving a federal health care benefit program. The first type of fraud covers activities related to federal health care programs, such as Medicare, Medicaid, TRI CARE, the Federal Employees Health Benefits Program (FEB), and the Veterans Health Administration (VA). The second type of fraud covers activities related to private health care benefit programs, such as private health insurance plans or employer-sponsored health care plans.