What is the difference between healthcare fraud and wire fraud?

On Behalf of | Feb 11, 2022 | Criminal Defense |

Whenever allegations arise of someone in the medical field committing fraud, it is usually assumed to be a case of healthcare fraud. However, there are distinct elements to healthcare fraud and other types of fraud. Quite often, allegations or charges surrounding a doctor or other medical professional accused of committing fraud do not amount to or involve healthcare fraud.

A recent case

In late January, the US Attorney’s Office for the Northern District of Illinois reported a fraud scheme that looks or sounds like healthcare fraud on the surface. In this case, the man accused, a dentist, allegedly “submitted fraudulent applications to a lending company for medical care loans that would purportedly finance certain patients’ dental care,” when he never intended to and did not in fact provide the care indicated.

The defendant is facing charges of wire fraud and not healthcare fraud; wire fraud is punishable by up to 20 years in federal prison where health care fraud is punishable up to 10 years in prison that only increased to 20 years if serious bodily injury is involved or life in prison if the violation results in death.

What is the difference between healthcare fraud and wire fraud?

Why is this case, which seems like an obvious case of healthcare fraud, be charged as wire fraud? The difference lies in the elements of the two respective crimes.

Healthcare fraud, as listed under 18 U.S. Code § 1347, involves any scheme to defraud a healthcare benefit program. Usually, healthcare fraud involves the defrauding of an insurance company by falsely billing for services never rendered or for overcharging for services.

On the other hand, wire fraud, 18 U.S. Code § 1343, involves transmitting communications by wire, radio or television communication in interstate or foreign commerce, to further a scheme to defraud. Wire fraud requires an intent to defraud, using wire communications across state or foreign lines. It says nothing about healthcare benefit programs as the intended victims, although health care fraud schemes can also be charged under the wire fraud statute and often are.

In the recent case of the dentist, the accusations involve the defrauding of a lending company, not a healthcare benefit program, so that is why the fraud scheme is likely charged as wire fraud rather than healthcare fraud.

What you need to know

It is important to know that healthcare fraud and wire fraud are handled differently by prosecutors and have differing elements under federal law that prosecutors much prove beyond a reasonable doubt to obtain a conviction. But either type of charge is very serious, with significant penalties resulting from a conviction. If you have been charged with healthcare fraud or wire fraud, your best approach is to work with an experienced criminal defense lawyer who can defend you against these serious charges that could result in a prison sentence upon conviction. Talk with attorney Darryl A. Goldberg today.


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