Health Care Fraud Charges Often Include a Count of Federal Wire Fraud. Here’s Why.
Try to imagine doing your job without the internet.
Modern medicine is very much a virtual enterprise. Everything from routine appointment scheduling and medical research to sensitive matters such as writing prescriptions and maintaining patient records ??it’s all portals, hard drives, and clouds.
So too is your mechanism for getting paid. Whether you are a doctor, a medical business owner, a pharmacist, or you work for any of the above, you probably submit invoices electronically?or at least someone in your clinic or company does. Invoices to insurance companies, to the government (for reimbursement via Medicare or Medicaid, for example), to hospitals you work with, to third-party business partners, and so on.
As with every other industry, health care uses computing and electronic transmission as an integral part of day-to-day operations.
But what’s different about most other industries is that they aren’t hounded by federal Strike Force offices that exist solely to investigate them, fine them, and put them in jail.
Health care professionals in this country are subjected to exactly that kind of scrutiny, and so they must be very careful not to arouse suspicion. Any investigation can prove disastrous, whether or not you’ve actually committed a crime.
Unfortunately, law enforcement is very eager to accuse you of criminal activity, especially health care fraud. Too often, prosecutors rush through the facts found in a routine audit or flimsy qui tam lawsuit, adopting a “prosecute first, figure out the truth later” stance. Indeed, criminal investigations are sometimes used simply as a tactic for applying pressure ??though you should never make the mistake of assuming a criminal matter is only a tactic, because these situations tend to spiral out of control as a rule, not as an exception.
It is precisely because of these two realities ? (1) the internet-dependent nature of contemporary health care and (2) the over-eagerness of government agents in the current “health care crackdown” environment ??that medical professionals must now worry about 18 USC ?1343: the federal wire fraud statute.
As we will see below, “wire fraud” is a broad term that makes very convenient ammunition for prosecutors. We’ll explain what 18 USC ?1343 is, how it’s used as a health care fraud crime, and how a medical fraud defense lawyer can help.
The Language of 18 USC ?1343
Title 18, Part 1, Chapter 63, Section 1343 of the United States Code is formally titled “Frauds by Wire, Radio, or Television,” though in practice, it encompasses much more than that.
Let’s begin by reading its full text (with our own emphasis added for the sake of readability):
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, transmits or causes to be transmitted by means of wire, radio, or television communication in interstate or foreign commerce, any writings, signs, signals, pictures, or sounds for the purpose of executing such scheme or artifice, shall be fined under this title or imprisoned not more than 20 years, or both.
If the violation occurs in relation to, or involving any benefit authorized, transported, transmitted, transferred, disbursed, or paid in connection with, a presidentially declared major disaster or emergency (as those terms are defined in section 102 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. ?5122)), or affects a financial institution, such person shall be fined not more than $1,000,000 or imprisoned not more than 30 years, or both.
When Does Wire Fraud Become Health Care Fraud?
Reading the language of 18 USC ?1343, it’s easy to assume the statute only applies to transmissions by television, radio, or old-fashioned wire transfers of funds. But as technology has evolved, the courts have consistently expanded those terms to include almost any kind of wired or electronic transmission. Today, wire fraud is inclusive of transmission by:
- Fax machine
- Most other “e-communications”
You and your staff probably use these technologies multiple times each day, and in some cases, even a distant connection between the wired transmission and the underlying health care fraud is enough to get members of your practice charged with both.
In fact, when conspiracy charges enter the mix too, even parties who didn’t engage in the wired transmission or the fraud itself can be charged for attempting, assisting, agreeing, or taking some very small part in those things.
However, the prosecution must be able to prove ? beyond a reasonable doubt ??that you intended to make the transmission as part of a scheme to defraud.
This can be difficult for the government to prove because no one can read your mind. However, because the courts accept several kinds of evidence of intent, it is not impossible. That’s why it is so important that you get an experienced medical fraud defense lawyer on your side early in the process.
Talk to Our Attorneys About Your Health Care Wire Fraud Matter Right Away
If you believe you or your clinic may be under suspicion of wire fraud or any other health care criminal matter, please contact the medical fraud law defense lawyers at Oberheiden, P.C. as soon as possible. We are standing by to learn about your case, answer your questions, and consider your legal options.
Our law firm offers free and confidential consultations for medical professionals with legal concerns, particularly in matters relating to health care fraud. Contact us right away.
Compliance ? Litigation – Defense
Dr. Nick Oberheiden has successfully represented healthcare executives and physicians – as well as businesses in the areas of toxicology, pharmacy, home health and hospice centers, DME, hospitals, surgery centers, neuro-monitoring, and blood and DNA testing centers – in healthcare compliance and defense.