Federal Laws for "False Statements Related to
Health Care Matters" (18 U.S.C. § 1035)
Explained by Nevada Criminal Defense Attorneys

In this article our Las Vegas criminal defense attorneys provide a summary of the federal crime of "making false statements to receive health care benefits" in Nevada.  Continue scrolling down to learn the law, potential defenses, and possible punishments.

Definition

It is a federal fraud crime to knowingly and willfully make false claims in order to gain or purchase health care.  Specifically, it is illegal to:

  1. falsify, conceal, or cover up a material fact by any trick, scheme, or device; or
  2. make any materially false, fictitious, or fraudulent statements or representations; or
  3. make or use any materially false writing or document knowing it to contain any materially false, fictitious, or fraudulent statement or entry,

in connection with the delivery of or payment for health care benefits, items, or services.

The purpose of this law is dissuade people from giving false information about their age, health, or financial situation in order to receive health care benefits or to pay less money for health care. Boulder City NV criminal defense attorney Neil Shouse gives an example:

Example: Jason from Reno applies for a supplement plan for Medicare even though he makes too much money to qualify.  On his application, he claims he earns thousands of dollars less than he does.  If he is caught, the U.S. Marshals Service could book Jason at the Washoe County Detention Center for making a materially false statement in order to receive health care.

Note that giving false information to get health care benefits is not a crime as long as the person honestly believed he/she was being truthful.  Only willful acts of trying to cheat the health care system are criminal under federal law. Henderson NV criminal defense attorney Michael Becker explains:

Example: Tony from Henderson applies for new health care and fails to disclose his preexisting condition.  If he is ever caught, he may be arrested and taken to the Henderson Detention Center for concealing a material fact related to health care.  But he should not be convicted if Tony honestly forgot to include the information.

Also note that making false statements to receive health care benefits is a state crime in Nevada as well as a federal crime.  Learn more in our article on the Nevada crime of health care fraud.

Defenses

There are two primary strategies for defending against allegations of the federal crime of making false claims relating to a health care benefit program:  1)  The information the defendant conveyed was truthful, and 2)  The defendant did not deliberately lie.

  1. No false claims. Health care companies are massive bureaucracies that are not above making mistakes.  Sometimes personnel or computers may misconstrue a claimant's paperwork as false when in fact the claimant is wholly accurate.  As long as the defense attorney can demonstrate that the health care company is the one in the wrong, then the charges should be dropped.

  2. No intent to defraud. Courts understand that there is nothing more confusing that filling out health care applications, and that there is nothing more frustrating that trying to get a health insurance company to deliver deserved benefits. Sometimes in this stressful process claimants unintentionally pass on false information or neglect to reveal material facts. If the U.S. Attorney's Office cannot prove beyond a reasonable doubt that these mistakes were knowingly made, then the defendant should not be convicted under 18 U.S.C. § 1035.

One other typical defense is that the cops conducted themselves unconstitutionally while investigating the charges.  In this case, a defense attorney could file a "Nevada motion to suppress evidence" with the court in the hopes that the judge will overlook any evidence found from illegal police activity.  If the judge grants the motion, the prosecution's case may be left too weakened to sustain a conviction.

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Penalties

Making false representations in connection with receiving health care benefits carries a sentence of up to five (5) years in Federal Prison and/or a fine.

Note that federal cases are heard in either the Lloyd D. George Federal Courthouse in Las Vegas or the Bruce R. Thompson Federal Courthouse in Reno.

Arrested?  Call . . . .

If you are facing federal charges for "presenting false statements relating to health care matters," call our Nevada federal criminal defense attorneys at 702-DEFENSE (333-3673) to consult free of charge.  We will do everything to try to get the case cleared up as favorably and swiftly as possible.

 

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