Source: https://rddjlaw.com/overview-of-pertinant-criminal-and-civil-statutes/
Timestamp: 2019-04-24 14:02:10+00:00

Document:
Overview of Pertinent Criminal and Civil Statutes | Ritchie, Dillard, Davies, & Johnson, P.C.
(2) 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.
(2) makes any materially false , fictitious, or fraudulent statements or representations, o r makes or uses any materially false writing or document knowing the same 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, shall be fined her this title or imprisoned not more than 5 years, or both.(b) As used in this section, the term “health care benefit program” h as the meaning given such term in section 24(b) of this title.
(2) corruptly gives, offers, or agrees to give anything of value to any person, with intent to influence or reward an agent of an organization or of a State, local or Indian tribal government, or any agency thereof, in connection with any business, transaction, or series of transactions of such organization, government, or agency involving anything of value of $5,000 or more; shall be fined under this title, imprisoned not more than 10 years, or both.
(B) in return for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under a Federal health care program , shall be guilty of a felony and upon conviction thereof, shall be fined not more than $25,000 or imprisoned for not more than five years, or both.
(B) to purchase, lease, order, or arrange for or recommend purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under a Federal health care program , shall be guilty of a felony and upon conviction thereof, shall be fined not more than $25,000 or imprisoned for not more than five years, or both.
(2) any State health care program , as defined in section 1320a-7(h) of this title.
(3) having knowledge of the occurrence of any event affecting (A) his initial or continued right to any such benefit or payment, or (B) the initial or continued right to any such benefit or payment of any other individual in whose behalf he has applied for or is receiving such benefit or payment, conceals or fails to disclose such event with an intent fraudulently to secure such benefit or payment either in a greater amount or quantity than is due or when no such benefit or payment is authorized, shall (I) in the case of such a statement, representation, concealment, failure, or conversion by any person in connection with the furnishing (by that person) of items or services for which payment is or may be made under the program, be guilty of a felony and upon conviction thereof fined not more than $25,000 or imprisoned for not more than five years or both, or (ii) in the case of such a statement, representation, concealment, failure, conversion, or provision of counsel or assistance by any other person, be guilty of a misdemeanor and upon conviction thereof fined not more than $10,000 or imprisoned for not more than one year, or both.
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 five years, or both. If violation affects a financial institution, such person shall be fined not more than $1,000,000 or imprisoned not more than 30 years, or both.
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, transmits or causes to be transmitted by means of wire, radio, or television communication in interstate or foreign commerce, any writings, signs, signals, pictures, or sounds for the purpose of executing such scheme or artifice, shall be fined under this title or imprisoned not more than five years, or both. If the violation affects a financial institution, such person shall be fined not more than $1,000,000 or imprisoned not more than 30 years, or both.
(ii) to avoid a transaction reporting requirement under State or Federal law, shall be sentenced to a fine of not more than $ 500,000 or twice the value of the property involved in the transaction, whichever is greater, or imprisonment for not more than twenty years, or both.
(ii) to avoid a transaction reporting requirement under State or Federal law, shall be sentenced to a fine of not more than $ 500,000 or twice the value of the monetary instrument or funds involved in the transportation, transmission, or transfer, whichever is greater, or imprisonment for not more than twenty years, or both. For the purpose of the offense described in subparagraph (B), the defendant’s knowledge may be established by proof that a law enforcement officer represented the matter specified in subparagraph (B) as true, and the defendant’s subsequent statements or actions indicate that the defendant believed such representations to be true.
(2), the term “represented” means any representation made by a law enforcement officer or by another person at the direction of, or with the approval of, a Federal official authorized to investigate or prosecute violations of this section.
(a) Whoever, in any of the circumstances set forth in subsection (d), knowingly engages or attempts to engage in a monetary transaction in criminally derived property that is of a value greater than $ 10,000 and is derived from specified unlawful activity, shall be punished as provided in subsection (b).
(b) (1) Except as provided in paragraph (2), the punishment for an offense under this section is a fine under title 18, United States Code, or imprisonment for not more than ten years or both. (2) The court may impose an alternate fine to that imposable under paragraph (1) of not more than twice the amount of the criminally derived property involved in the transaction.
(c) In a prosecution for an offense under this section, the Government is not required to prove the defendant knew that the offense from which the criminally derived property was derived was specified unlawful activity.
(2) that the offense under this section takes place outside the United States and such special jurisdiction, but the defendant is a United States person (as defined in section 3077 of this title, but excluding the class described in paragraph (2)(D) of such section).
(3) makes or uses any false writing or document knowing the same to contain any materially false , fictitious, or fraudulent statement or entry ; shall be fined under this title or imprisoned not more than 5 years, or both.
No one can avoid responsibility for a crime by deliberately ignoring the obvious . . . The defendant was aware of a high probability that [there was a violation of criminal laws] and that the defendant deliberately closed his eyes to what was obvious. Carelessness, or negligence, or foolishness on his part is not the same as knowledge, and is not enough to convict.Pattern Criminal Jury Instructions, United States Court of Appeals for the Sixth Circuit, ¶2.09 (Deliberate Ignorance).
In the case of the mail fraud statute, judicial construct ion has made the problem of vagueness even worse. This is illustrated most clearly by the “definition” of “scheme to defraud” which has been used in this circuit: [T]he scheme to defraud element required under § 1341 is not defined according to a technical standard. The standard is a “reflection of moral uprightness, of fundamental honesty’ fair play and right dealing in the general and business life of members of society.” United States v. Bruce , 448 F.2d 1224, 1229 (5th Cir. 1973), quoting Gregory v. United States , 253 F.2d 104, 109 (5th Cir. 1958). United States v. Van Dyke , 605 F.2d 220, 225 (6th Cir. 1979).
In this case, the jury was given the Van Dyke instruction over objection.
The False Claims Act (FCA) is a civil remedy used by the government to obtain the proceeds of fraud in benefits programs, including the health care field. This act essentially mirrors the criminal statutes for fraudulent claims, except the standard of proof is lower (by the preponderance of the evidence) and the knowledge element is more less strict.
(3) acts in reckless disregard of the truth or falsity of the information, and no proof of specific intent to defraud is required. 31 U.S.C. § 3729 (b) (emphasis added).
The government can recover from $5000 to $10,000 per false claim, plus three (3) times the amount of damages sustained by the government.
Another potential area of civil liability is a Qui Tam action. A Qui Tam action is embedded within the False Claims Act at 31 U.S.C. § 3730. A Qui Tam action is filed under seal with a federal district court by a “relator,” on behalf of himself and the government. The government then, after investigation, elects to proceed with the action or declines to proceed (although it may intervene later if it declines). If the government elects to proceed, the relator can receive as much as 15% to 25% of the proceeds of the action or settlement. If the government declines, the relator can receive as much as 25% to 30% of the proceeds or settlement, including reasonable expenses and costs.
(e) Certain actions barred.–. . .
(4)(A) No court shall have juris diction over an action under this section based upon the public disclosure of allegations or transactions in a criminal, civil, or administrative hearing, in a congressional, administrative, or Government Accounting Office report, hearing, audit, or investigation, or from the news media, unless the action is brought by the Attorney General or the person bringing the action is an original source of the information. (B) For purposes of this paragraph, ” original source ” means an individual who has direct and independent knowledge of the information on which the allegations are based and has voluntarily provided the information to the Government before filing an action under this section which is based on the information. 31 U.S.C. § 3730(3)(e)(4)(A) and (B).
If the person bringing the action is convicted of criminal conduct arising from his or her role in the violation of section 3729, that person shall be dismissed from the civil action and shall not receive any share of the proceeds of the action. Such dismissal shall not prejudice the right of the United States to continue the action, represented by the Department of Justice. 31 U.S.C. § 3730(d)(3).
Price Reductions Offered by Contractors with Substantial Financial Risk to Managed Care Organizations The safe harbors listed above are codified at 42 C.F.R. § 1001.952.
In Federal Recovery Services, Inc. v. United States, 72 F.3d 447, 450 (5th Cir. 1995, the Fifth Circuit held that there was a jurisdictional bar on documents based upon the public disclosure provision when: Any information disclosed through civil litigation and on file with the clerk’s office should be considered a public disclosure of allegations in a civil hearing for the purposes of § 3730(e)(4)(A). (Quoting United States, ex rel. Siller v. Becton, Dickson and Co., 21 F.3 1339, 1350 (4th Cir.), cert. denied 513 U.S. 928 (1994).

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