Health Care Fraud

Title 18 U.S.C. § 1347 provides a general statute criminalizing Health Care fraud:

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, 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."

Depending upon the health care benefit program, a separate prosecution may result under Texas' Medicaid Fraud statute. Additionally, a person may be liable under other theories of liability, namely, Theft or Embezzlement from an Employee Benefit Plan or Theft or Embezzlement in Connection with a Health Care Benefit Program.