Health Care Fraud

"Cover of the Quick Facts handout"

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] 

Click the cover for the PDF handout or learn more below. 

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%).
       
  • 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%.
         
    • 6.1% received some other downward departure.
      • Their average sentence reduction was 67.1%.
         
  • 45.0% received a variance; of those individuals: 
    • 99.5% received a downward variance.
      • Their average sentence reduction was 54.5%.
         
    • 0.5% received an upward variance.[6] 

 

 

 

 

  • 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.

[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.

[4] The Loss Table was amended effective November 1, 2001 and November 1, 2015.

[5] The Victims Table and Sophisticated Means adjustment were amended effective November 1, 2015.

[6] The Commission does not report the average for categories with fewer than three cases.

SOURCE: United States Sentencing Commission, FY 2019 through FY 2023 Datafiles, USSCFY19-USSCFY23.