Individual and Offense Characteristics

• 69% of individuals sentenced for health care fraud were men.
   
• 45% were White, 15% were Hispanic, 21% were Black, and 9% were Other races.
   
• Their average age was 52 years. 
   
• 91% were United States citizens.
   
• 91% had little or no prior criminal history (Criminal History Category I).
   
• 69% received the adjustment at USSG §4C1.1 for zero criminal history points.
   
• The median loss for these offenses was $1,279,436;³
  • 24% involved loss amounts of less than $250,000;
  • 13% involved loss amounts greater than $9,500,000.
     
• Sentences were increased for:
  • the number of victims or the extent of harm to victims (13%);⁴
  • conviction of a federal health care offense and a loss of more than $1 million (46%);
  • using sophisticated means to execute or conceal the offense (12%);
  • using an unauthorized means of identification (4%);
  • a leadership or supervisory role in the offense (18%);
  • abusing a public position of trust or using a special skill (33%);
  • obstructing or impeding the administration of justice (5%).
     
• Sentences were decreased for:
  • minor or minimal participation in the offense (6%).
     
• The top five districts for individuals sentenced for health care fraud offenses were:
  • District of New Jersey (30);
  • Southern District of Florida (30);
  • District of Puerto Rico (23);
  • Eastern District of Michigan (22);
  • Eastern District of New York (20).

Punishment

• The average sentence for individuals sentenced for health care fraud was 21 months. 
   
• 68% were sentenced to prison. 
   
• 3% were convicted of an offense carrying a mandatory minimum penalty; 56% of those individuals were relieved of that penalty.

Sentences Relative to the Guideline Range 

• 59% of sentences for health care fraud were under the Guidelines Manual:
  • 23% were within the guideline range.
     
  • 32% were substantial assistance departures.
    • The average sentence reduction was 79%.
       
  • 3% were some other downward departure.
    • The average sentence reduction was 81%.
       
  • 0.3% were upward departures. 
     
• 41% of sentences for health care fraud were variances.
  • 41% were downward variances.
    • The average sentence reduction was 59%.
       
  • 1% were upward variances.⁵

• The average guideline minimum has fluctuated and average sentence imposed has remained steady over the past five years.
  • The average guideline minimum increased and decreased throughout the fiscal years. The average guideline minimum was 51 months in fiscal year 2020 and 50 months in fiscal year 2024.
     
  • The average sentence was 30 months in fiscal year 2020 and 27 months in fiscal year 2024.

¹ Health care fraud includes cases 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 and where the offense conduct as described in the Presentence Report involved the defrauding of a government or private health care entity.

² Cases with incomplete sentencing information were excluded from the analysis. 

³ The Loss Table was amended effective November 1, 2001 and November 1, 2015.

⁴ The Victims Table and Sophisticated Means adjustment were amended effective November 1, 2015.

⁵ The Commission does not report the average for categories with fewer than three cases.

⁶ “Early Disposition Program” (or EDP) departures are departures where the government sought a sentence below the guideline range because the defendant participated in the government’s Early Disposition Program, through which cases are resolved in an expedited manner. See USSG §5K3.1.