Of the 64,124 cases reported to the Commission in fiscal year 2023, 447 involved health care fraud (up 4.2% since FY 2019). [1], [2], [3]
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Individual and Offense Characteristics
- 67.6% of individuals sentenced for health care fraud were men.
- 40.9% were White, 27.1% were Black, 23.7% were Hispanic, and 8.3% were Other races.
- Their average age was 50 years.
- 89.9% were United States citizens.
- 89.5% had little or no prior criminal history (Criminal History Category I).
- The median loss for these offenses was $1,416,231;[4]
- 24.4% involved loss amounts of less than $250,000;
- 4.7% involved loss amounts greater than $9,500,000.
- Sentences were increased for:
- the number of victims or the extent of harm to victims (19.2%);[5]
- conviction of a federal health care program and a loss of more than $1 million (35.1%);
- using sophisticated means to execute or conceal the offense (17.2%);
- using an unauthorized means of identification (6.9%);
- a leadership or supervisory role in the offense (22.1%);
- abusing a public position of trust or using a special skill (26.6%);
- obstructing or impeding the administration of justice (4.9%).
- Sentences were decreased for:
- minor or minimal participation in the offense (5.8%).
- minor or minimal participation in the offense (5.8%).
- The top five districts for individuals sentenced for health care fraud were:
- Southern District of Florida (79);
- Southern District of New York (36);
- Northern District of Ohio (34);
- Central District of California (29);
- District of New Jersey (26, tie);
- Eastern District of Michigan (26, tie).
Punishment
- The average sentence for individuals sentenced for health care fraud was 27 months.
- 73.6% were sentenced to prison.
- 2.2% were convicted of an offense carrying a mandatory minimum penalty; of those individuals, one was relieved of that penalty.
Sentences Relative to the Guideline Range
- Of the 55.0% of all individuals sentenced for health care fraud under the Guidelines Manual:
- 35.4% were sentenced within the guideline range.
- 56.9% received a substantial assistance departure.
- Their average sentence reduction was 69.5%.
- Their average sentence reduction was 69.5%.
- 6.1% received some other downward departure.
- Their average sentence reduction was 67.1%.
- Their average sentence reduction was 67.1%.
- 35.4% were sentenced within the guideline range.
- 45.0% received a variance; of those individuals:
- 99.5% received a downward variance.
- Their average sentence reduction was 54.5%.
- Their average sentence reduction was 54.5%.
- 0.5% received an upward variance.[6]
- 99.5% received a downward variance.
- The average guideline minimum remained steady and average sentence imposed slightly decreased over the past five years.
- The average guideline minimum increased from 46 months in fiscal year 2019 to 48 months in fiscal year 2023.
- The average sentence imposed decreased from 34 months in fiscal year 2019 to 27 months fiscal year 2023.
- The average guideline minimum increased from 46 months in fiscal year 2019 to 48 months in fiscal year 2023.
[1] Cases with incomplete sentencing information were excluded from the analysis.
[2] Theft, property destruction, and fraud offenses include cases with complete guideline application information in which the individual was sentenced under §2B1.1 (Larceny, Embezzlement, and Other Forms of Theft; Offenses Involving Stolen Property; Property Damage or Destruction; Fraud and Deceit; Forgery; Offenses Involving Altered or Counterfeit Instruments Other than Counterfeit Bearer Obligations of the United States) using a Guidelines Manual in effect on November 1, 2001 or later. See www.ussc.gov/research/quick-facts for the Quick Facts on §2B1.1 individuals.
[3] Health care fraud includes cases where the offense conduct as described in the Presentence Report involved the defrauding of a government or private health care entity.
SOURCE: United States Sentencing Commission, FY 2019 through FY 2023 Datafiles, USSCFY19-USSCFY23.