Affordable Care Act Fraud Criminals Facing Tougher Sentences

Due to the Affordable Care Act, criminals convicted of fraud now face tougher sentences and more jail time. Criminals will receive 20 to 50 percent longer sentences for crimes that involve more than $1 million in losses.

“The government’s successes in prosecuting and winning health care fraud cases result from continued interagency collaboration such as Medicare Strike Force (Strike Force) and Health Care Fraud Prevention Enforcement and Action Team (HEAT) investigations. In press releases, the government has touted the ties between the Department of Justice (DOJ), the Federal Bureau of Investigation (FBI), the Department of Health and Human Services’ Office of the Inspector General (HHS-OIG), and local United States Attorneys’ Offices (USAOs) and Medicaid Fraud Control Units (MFCUs) in health care fraud investigations. Coordination among the agencies has increased in recent years. These established ties make it easier for the agencies to detect, investigate, and prosecute large-scale fraud schemes. As advanced data-mining techniques further strengthen the links between investigatory and enforcement agencies, large-scale investigations and prosecutions will become even easier for the government to pursue in the coming years.

Another strategy that the federal government is employing with growing success is filing charges under broadly worded criminal statutes that are not specific to health care fraud and that, perhaps more importantly, do not require proof of specific intent. By bringing charges under such statutes, the government is able to capture a wider range of conduct than that covered by health-care-specific statutes, and reduce the evidence of criminal intent or activity necessary to secure a plea, conviction, or settlement agreement. Such a strategy shifts the balance of power heavily in the government’s favor with respect to both investigation and enforcement efforts. With broad discretion to file charges that require less proof of intent, the government can use the threat of conviction to secure more favorable pleas and settlements.”

Source: (U.S. Department of Health and Human Services, 2013)