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Federal Healthcare Fraud Penalties in DC

Federal healthcare fraud is an extremely serious charge. The penalties for healthcare fraud cases are governed by federal sentencing guidelines. Many agencies are involved in gathering appropriate evidence, and helping to build a case against any individual who has been accused of such a crime. With penalties including hefty fines and extensive amounts of jail time, it is essential that any individual facing such a charge contact an attorney immediately. It is crucial for any individual facing federal healthcare fraud, with the help of a knowledgeable attorney, to gather all the relevant evidence to ensure a positive outcome for your case before penalties occur.

Investigating Evidence

Many of the agencies that fall under the umbrella of Health and Human Services have an Office of the Inspector General who will often conduct investigations into fraudulent billing and things of that nature. Those OIG offices will work closely with United States Attorney’s Office in order to build a case, and put themselves in a position to bring an indictment against individuals that they alleged have violated the healthcare laws.

These cases often document intensive evidence, and will frequently have a paper trail that shows a pattern of conduct. The government will try to seek to flip witnesses that are participants in the conspiracy to testify against those that they deem to be the leaders. There is often instances of first-hand testimony.

Range of Penalties

The range of penalties for federal healthcare fraud in DC span the gamut from little jail time to very high amounts of jail time depending on:

  • How egregious the conduct was
  • The amount of economic loss, or the amount of money involved (called an advisory guideline range)
  • The surrounding circumstances of the arrest.

Attorneys ask many questions when determining how to approach penalties in a federal healthcare fraud case. Was there a criminal conspiracy involved? How did the activity come about? Title 18 U.S.C. § 3553(a) requires a judge to look at the nature and circumstances of the offense. In addition, the judge must consider the characteristics of the person being sentenced to determine what would deter the general public and deter this specific person from committing a further crimeOne of the goals of the penalty is to promote respect for the law and to have immediate treatment or education services provided to a person convicted of fraudThe judge must look at the statute and take into account all of the factors when making a sentencing decision. 


In a federal healthcare fraud case in DC, the sentence can vary. Often, sentences can be 24, 36or 48 months, however they can also be higher or lower, but the penalty is typically for several years. They depend entirely on what the conduct was, what the individual was charged with, and what the circumstances were. Attorneys will often wonder:

  • Did the individual take a plea?
  • Did the individual offer the government any assistance in investigating their cases?
  • Were there any extenuating circumstances under which this conduct occurred?

All of these individualized factors will be considered by a judge when determining a sentence.

Long-Term Implications

The longterm implications of a DC healthcare fraud conviction are quite serious because of the penalties that may occur. A person can be prohibited from dealing with a healthcare organization or government healthcare programs such as Medicare and Medicaid. That essentially prohibits a doctor from practicing medicine. The person’s medical license can be revoked. There are other restrictions as far as the ability to own firearms and the ability to voteThere are collateral consequences from a conviction in addition to the possibility of prison and being on probation or supervised release. Call a Federal healthcare fraud attorney to help with legal actions regarding penalties. 

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