What is the Statute of Limitations for Federal Healthcare Fraud?

The United States government has established stringent regulations and penalties for anyone convicted of healthcare fraud. Healthcare fraud can be prosecuted either criminally or civilly under a variety of prosecutorial theories, including mail fraud, (940. 18 U.S.C. § 1341), wire fraud (940. 18 U.S.C. § 1343), fraud against the government (18 U.S. Code § 1031), and program fraud and bribery (18 U.S. Code § 666). 


An important aspect of prosecuting healthcare fraud is the Statute of Limitations (SOL), which sets the maximum time after an event within which formal charges can be initiated. At Stechschulte Nell, Attorneys at Law, we believe that anyone facing a serious criminal indictment such as healthcare fraud should know the full scope of possible defenses that may be effective in preventing a conviction.  


We hope this article explaining the statute of limitations is helpful to you in understanding this aspect of criminal law. 



Understanding Healthcare Fraud 


Healthcare fraud encompasses a wide range of illegal activities, including billing for services not rendered, filing duplicate claims, altering service dates or locations, and falsifying the nature of services provided, paying or accepting kickbacks and bribery, and others.  


These criminal acts can be committed by healthcare providers, facilities, or patients. 


Statute of Limitations for Federal Healthcare Fraud 


The Statute of Limitations for federal healthcare fraud is primarily governed by 18 U.S.C. § 3282, the federal statute that dictates a 5-year statute of limitation for most non-capital offenses. However, there are specific circumstances related to healthcare fraud that can extend this period in some cases. 


 For example, the False Claims Act (FCA) allows for civil actions to be brought up to six years from the date of the fraudulent act or three years after the government knows or should have known of the material facts of the false claim, but not more than ten years after the violation. 


Another law that can further extend the statute of limitation in healthcare fraud cases is the Wartime Suspension of Limitations Act (WSLA). The WSLA suspends the SOL for any offense involving fraud against the government when the United States is at war or when Congress has enacted specific authorizations for the use of the armed forces. This statute suspends the statute of limitations on federal healthcare fraud cases until 5 years after the military hostilities have stopped.  


Other Important Extensions to the Healthcare Fraud Statute of Limitations 


The statute of limitations might seem to laymen to be a closing date for potential prosecution in every case. However several exceptional circumstances, if proven by the prosecution, can extend the SOL for healthcare fraud charges. These are some of the primary grounds for extending the statute of limitation for healthcare fraud beyond the time set by the general rule: 


Discovery Rule 


In cases where fraud is concealed, and the government could not have discovered the offense through reasonable diligence, the SOL may begin to run from the time the fraud is ultimately discovered, not when the fraud occurred. This ground for extending the statute of limitations will be challenged by the defendant’s skilled healthcare fraud defense lawyer.  


The challenge includes citing the actions the government could have and should have taken during the time it claims ignorance of the fraud that would have exposed sufficient facts to put the government on notice.  


Agreement to Toll 


Parties may agree to toll the SOL, essentially pausing the countdown, often to allow for ongoing settlement discussions or further investigation. This situation may seem unlikely to arise, but an experienced healthcare fraud attorney may be able to obtain a very favorable result for their client in these circumstances.  


If productive negotiations between the prosecution and the defense are ongoing, a ticking statute of limitation clock may force the government to file charges despite being close to a favorable result for the client. In this case, the defense may consider it wiser to grant more time to the government rather than forcing them to indict the defendant before the SOL expires.  


Ongoing Fraud 


For healthcare fraud schemes or conspiracies that continue over time, each fraudulent act may start a new SOL period, potentially extending the time frame within which prosecutors can bring charges against the suspect.  


Defenses Related to the Statute of Limitations 


The defense can raise the expiration of the SOL as a defense, arguing that the government’s charges are time-barred. Successfully arguing that the SOL has expired requires careful analysis of the timeline of alleged fraudulent acts, the applicability of any exceptions, and the precise dates when the government became aware of the material facts of the fraud. 


Raise It or Waive It? 


Federal healthcare fraud is a serious crime and a potential cause of massive financial penalties. Only criminal defense lawyers with the most experienced and sharpest legal minds should be trusted with the life and liberty of a defendant facing these charges. 


If a less experienced or less attentive attorney is engaged as a defense lawyer, they may miss the statute of limitations defense and fail to formally raise it as a legal defense. The statute of limitations is known as an “affirmative defense,” meaning it must be raised and proven by the defendant to be an effective bar to prosecution. 


If a defendant’s lawyer fails to raise the SOL as a defense, they may have waived the defense. In this unfortunate scenario, a defendant may be convicted and sentenced to prison for a crime that was filed against them after the statute of limitations expired. In most cases, they are barred from raising the defense later. 


Read More > The Penalties for Federal Healthcare Fraud  


Get an Experienced Federal Healthcare Fraud Criminal Defense Lawyer 


The statute of limitations in federal healthcare fraud cases is an essential issue that must be analyzed given the specific facts of each case. There is no substitute for experience when the life of the defendant and the future of the livelihood and family hangs in the balance.  


If you are under investigation or facing indictment for healthcare fraud in Florida, contact Stechschulte Nell, Attorneys at Law at 813-280-1244 today.  

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