Why Medical Professionals Need to Be Aware of Mail Fraud (Even if You Don’t Think You’re Committing It)
Where there’s a will, there’s a way.
For federal law enforcement, the will is to arrest, convict, and sentence as many people as possible. The higher the defendant’s profile, the better. High-profile takedowns make for juicy news, bolstering the prosecutors’ professional reputation and bringing more money into the government (in the form of fines, fees, reimbursements, and the prison system). For those reasons and more, the will is very strong.
The way can take many forms. In truth, federal agents have many, many ways to bring criminal charges against health care professionals (pharmacists, surgeons, doctors, billing coordinators, nurses, physician assistants, corporate board members of medical companies? the list goes on). Congress has given the government an extensive menu of criminal statutes to choose from, and judicial interpretation has expanded the options even further over the years.
One of the most common “ways” is found in 18 USC ?1341: the federal mail fraud statute.
On its face, Section ?1341 is not specific to the health care industry. Any kind of mail fraud will do (and we’ll look at exactly what “mail fraud” means below). Nevertheless, ?1341 has proven especially popular among prosecutors and grand juries in health care criminal cases.
In today’s article, we explore the government’s use of the mail fraud statute as a health care crime? and why medical professionals in this country must be so very careful not to run afoul of it.
The Language of 18 USC ?1341
Title 18, Part 1, Chapter 63, Section ?1341 of the United States Code is formally titled “Frauds and Swindles” but is more widely known as the federal mail fraud law, and it reads as follows (with emphasis added for clarity’s sake):
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 counterfeit or spurious coin, obligation, security, or other article, or anything represented to be or intimated or held out to be such counterfeit or spurious article, for the purpose of executing such scheme or artifice or attempting so to do, places in any post office or authorized depository for mail matter, any matter or thing whatever to be sent or delivered by the Postal Service, or deposits or causes to be deposited any matter or thing whatever to be sent or delivered by any private or commercial interstate carrier, or takes or receives therefrom, any such matter or thing, or knowingly causes to be delivered by mail or such carrier according to the direction thereon, or at the place at which it is directed to be delivered by the person to whom it is addressed, any such matter or thing, 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.
Mail Fraud Means More Than Just “A Stamp and a Scam”
The classic image of mail fraud involves a con artist writing a duplicitous letter to an unwitting victim for the purpose of swindling that person’s money away from them, then sticking that letter in a stamped envelope and dropping it in the nearest USPS mailbox for 5:00 p.m. pickup.
But the meaning of mail fraud under 18 USC ?1341, as Congressionally defined and judicially interpreted, is broader than that.
For one thing, “mail” means more than the United States Postal Service. Any kind of mail service is sufficient to trigger the statute, including:
- Any other private mail courier / delivery service
There are countless alternatives to the traditional U.S. mail service today, and many companies now contract with smaller or regional delivery services to process packages and letters (perhaps as a go-between for the company and USPS). Any of these services can constitute “mail” under 18 USC ?1341. For that matter, hand delivery might even be sufficient in some cases.
Moreover, you don’t have to physically drop something in the mail to commit mail fraud. For example, we’ve seen credit card fraud cases where the defendant was also convicted of mail fraud under 18 USC ?1341 simply because a credit card statement connected to the fraud was mailed to the victim. In other words, the connection to the “mail” can be relatively distant and still lead to conviction.
Health Care Mail Fraud Charges Give the Government Additional Tools
In health care, fraud charges frequently stem from the submission of claims for payment ??either to CMS or a private insurer. If those claims travel through a mail system of any kind, you could be charged under 18 USC ?1341. (If the submissions are entirely electronic, you might face a wire fraud charge instead.)
The government loves for 18 USC ?1341 to appear on indictments because, among other things, it allows them to freeze your assets ? one more tool to leverage against you.
Under Suspicion of Medicare Mail Fraud? Contact Oberheiden, P.C. Right Away.
The Medicare mail fraud law attorneys at Oberheiden, P.C. are here to answer your questions, review your options, and develop effective strategies for ending investigations and keeping you out of prison.
We offer free and confidential consultations for medical professionals who have 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.