Health Care Fraud - Elements of the Offense (18 U.S.C. Sec. 1347) (revised 2015)
About this form
The Health Care Fraud - Elements of the Offense form outlines key legal elements necessary to prosecute health care fraud under 18 U.S.C. Sec. 1347. This legal form is designed for use in federal court cases where a defendant is charged with committing health care fraud, which involves schemes to defraud health care benefit programs through false representations or promises. It differs from similar forms as it specifically details the necessary components that must be proven for a conviction, focusing on intent to defraud and the relationship to health care services.
Key components of this form
- Definition of the offense and legal basis under 18 U.S.C. Sec. 1347.
- Three elements that must be proven for a conviction: scheme to defraud, intent to defraud, and relation to health care benefit programs.
- Specific references to both public and private health care benefit programs.
- Clarification on the understanding of "execution of the scheme" in relation to counts of offense.
- Jury instructions related to associated fraud offenses such as mail or wire fraud.
When to use this document
This form should be used by legal professionals when preparing an indictment for a defendant accused of health care fraud. It is applicable in cases where fraudulent schemes have been devised to unlawfully obtain funds from health care benefit programs. Situations may include fraudulent billing for services not rendered, misrepresentation of treatments, or the acquisition of patient data for the purpose of cheating health care systems.
Intended users of this form
Eligible users of this form include:
- Attorneys representing the government in health care fraud cases.
- Judges overseeing trials related to health care fraud indictments.
- Legal scholars and students studying criminal law focused on health care fraud.
- Any stakeholders involved in the legal proceedings pertaining to health care fraud allegations.
Instructions for completing this form
- Identify the defendant's name in the indictment.
- Clearly outline the alleged fraudulent scheme perpetrated against the victim entity.
- Specify the intent to defraud that the government must prove beyond a reasonable doubt.
- Detail the nature of the health care benefit program involved.
- Include any additional instructions from the court or related jury instructions regarding the standard of proof.
Notarization guidance
In most cases, this form does not require notarization. However, some jurisdictions or signing circumstances might. US Legal Forms offers online notarization powered by Notarize, accessible 24/7 for a quick, remote process.
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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.
Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
Typical mistakes to avoid
- Failing to establish a clear link between the fraudulent scheme and the health care benefit program.
- Omitting critical evidence needed to demonstrate intent to defraud.
- Neglecting to provide specific definitions for the terms used in the indictment.
- Using language that can confuse the jury regarding the elements of the offense.
Benefits of using this form online
- Convenient access to comprehensive legal information on health care fraud.
- Editable templates allow for customization based on specific case details.
- Instant availability for legal professionals and defendants when time is critical.
- Confidence in using forms prepared by licensed attorneys to ensure legal compliance.
Legal use & context
- This form should be used in federal criminal proceedings, as health care fraud is a federal offense.
- The elements outlined must be proven in a court of law for a conviction under the federal statute.
- Misinterpretation of intent or the nature of the scheme can lead to legal challenges in court.
Key takeaways
- The Health Care Fraud - Elements of the Offense form is crucial for establishing the components of fraud cases.
- Clear documentation and adherence to legal definitions are critical for successful prosecution.
- Understanding the nuances of existing laws and related case law will aid legal professionals in effectively utilizing this form.
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FAQ
In California, healthcare fraud is considered a ?wobbler? crime, which means it can be charged as a misdemeanor or a felony. Typically, the prosecutor decides based on the amount of money involved.
Examples of Health Insurance Fraud Falsifying a patient's diagnosis to justify the need for tests, surgeries, or other procedures that are not medically necessary. Misrepresenting procedures performed to obtain payment for non-covered services, such as cosmetic surgery.
Members can commit health care fraud by providing false information when applying for programs or services, forging or selling prescription drugs, using transportation benefits for non-medical related purposes, and loaning or using another's insurance card.
The five most important Federal fraud and abuse laws that apply to physicians are the False Claims Act (FCA), the Anti-Kickback Statute (AKS), the Physician Self-Referral Law (Stark law), the Exclusion Authorities, and the Civil Monetary Penalties Law (CMPL).
Other forms of fraud and abuse in health care. Billing for services not rendered medically necessary. Double-billing for services rendered. Billing for covered service when the service provided was not covered.
Whoever, having devised or intending to devise any scheme or artifice to defraud, or for obtaining money or property by means of false or fraudulent pretenses, representations, or promises, or to sell, dispose of, loan, exchange, alter, give away, distribute, supply, or furnish or procure for unlawful use any
As a result, 18 U.S.C. § 1347 prohibits health care fraud broadly, prohibiting anyone from knowingly or willfully attempting ?to execute, a scheme or artifice? to defraud any health care benefit program or obtain money in connection with delivery or payment of health care benefits, items, or services.
Examples: A physician knowingly submits claims to Medicare for medical services not provided or for a higher level of medical services than actually provided.
