HIPAA Fraud Conviction For Non Health Care Providers Affirmed.

In US v. Lucien the 2nd Cir. Court of Appeals affirmed for the first time the conviction and penalties assessed against defendants who were not health care providers. The Defendants engaged in a scheme to defraud the no-fault auto insurance program of New York state by staging accidents and having the passengers assign claims to health care providers and themselves filing claims for cash settlements. The defendants argued that the no-fault program was not a health care benefit program and that the statute was intended to prevent fraud by health care providers.

In US v. Lucien the 2nd Cir. Court of Appeals affirmed for the first time the conviction and penalties assessed against defendants who were not health care providers. The Defendants engaged in a scheme to defraud the no-fault auto insurance program of New York state by staging accidents and having the passengers assign claims to health care providers and themselves filing claims for cash settlements. The defendants argued that the no-fault program was not a health care benefit program and that the statute was intended to prevent fraud by health care providers. The Second Circuit held they were wrong on both counts under the plain language of the statute.

Sec. 1347. - Health care fraud

Whoever knowingly and willfully executes, or attempts to execute, a scheme or artifice - to defraud any health care benefit program; or 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.