Health Care Fraud Statutes That Apply To Visiting Nurses

Criminal Statutes
Health Care Fraud 18 U.S.C. Section 1347
As a visiting nurse, you might be accused of health care fraud if it is alleged that you have tried to defraud a health care benefit program in relation to your nursing services for the purposes of receiving a benefit or good.

The elements of health care fraud include knowingly and willfully attempt to defraud a health care benefit program for the purpose of obtaining payment or benefit from the health care program.

Penalties For Violating the Federal Health Care Fraud Statute
As a visiting nurse, if you are found guilty for violating the basic health care fraud statute, you could be subject to:

• A fine, 10 years in prison time, or both;
• 20 years in prison if your actions resulted in serious bodily injury or death

Anti-Kickback 42 U.S.C. 1320a-7b(b)
As a visiting nurse, you could be charged with violating the anti-kickback statute if it is alleged that you had accepted money for making a referral to for additional care for a patient when the patient did not need the additional care, but you did so because of an agreement with another healthcare practitioner.

The elements of anti-kickback include knowingly and willfully soliciting or receiving any remuneration in return for referring a patient or arranging services (including goods) that are part of a health care program

Penalties For Violating the Federal Anti-Kickback Statute
As a visiting nurse, if you are found guilty for violating the anti-kick statute you are subject to up to five years of imprisonment or a fine up to $25,000 or both. These penalties can be applied to each act for which you are convicted.

Civil Statutes
False Claims Act – 31 U.S.C 3729-3733
The false claims act is the civil counterpart to the criminal health care fraud charge. Essentially, as a visiting nurse, you can be civilly sued for claiming that your provided nursing medical services to a patient even though you really did not conduct nor complete any services.

Penalties For Violating The False Claims Act
Once you are alleged to have committed an act that that violates the False Claims Act, you will be subject to a fine that generally will range from $5,000 to $10,000. Each case is different, and the type of fine will vary depending on your particular your case. 

It is important to know that this fine is merely a statutory fine, but there could be additional fines that could be ordered depending on the damages sustained by the government due to your actions. Even in situations where you enter into a settlement, fines are likely.

Criminal Punishment vs. Civil Punishment
The difference between criminal punishment and civil penalties is that they can also come with a potential prison term along with the fine that may be imposed against you. As you might have assumed, the criminal penalties are far more serious than civil penalties. 

While a sentence does not guarantee prison, it is a possibility. Fines for criminal punishment focus on both punishment and restitution.