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 (as defined in section 1365 of this title), 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.
Related statutes:
Criminal Penalties for Acts Involving Federal Health Care Programs (42 U.S.C. § 1320a-7b). Individuals and entities are prohibited from "knowingly and willfully" making false statements or representations in applying for benefits or payments under all federal and state health care programs. Individuals also are prohibited from fraudulently concealing or failing to disclose knowledge of an event relating to an initial or continued right to benefits or payments. There is also a prohibition against knowingly and willfully soliciting or receiving any remuneration (including any kickbacks, bribe or rebate) directly or indirectly, in cash or in kind in exchange for referrals; or in return for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under a Federal health care program. Violations may result in a felony conviction, with penalties including imprisonment for up to five years and a fine of up to $25,000. (Related safe harbor regulations define payment practices that are not within the meaning of prohibited "remuneration." The regulations provide immunity from criminal prosecution and civil exclusion for payment practices that fall within the safe harbor. Failure to fall within a safe harbor, however, does not mean that a payment arrangement necessarily violates the statute. Current safe harbors address: investment interests; space rental; equipment rental; personal services and management contracts; practice sale; referral services; warranties; discounts; employment relationships; waiver of co-insurance and deductible amounts; group purchasing organizations; increased coverage or reduced cost sharing under a risk-basis or prepaid plan; and charge reduction agreements with health plans.)
Theft or Embezzlement in Connection with Health Care Benefit Program (18 U.S.C. § 669). Prohibits knowingly and willfully embezzling, stealing, or otherwise without authority converting or intentionally misapplying money or property of a health care benefit program. Potential penalties include fines and imprisonment for up to 10 years. Where the value of the property at issue is $100 or less, maximum imprisonment will be for one year.
Obstruction of Criminal Investigations of Health Care Offenses (18 U.S.C. § 1518). Anyone who willfully prevents, obstructs, misleads, or delays or attempts to prevent the communication of information or records relating to a violation of a federal health care offense to a criminal investigator may face fines and up to five years imprisonment.
False Statements Relating to Health Care Matters (18 U.S.C. § 1035). Anyone who knowingly and willfully falsifies or conceals a material fact or makes a materially false fictitious or fraudulent statement in connection with the delivery of or payment for health care benefits, items or services may face fines and up to five years imprisonment.