H.R. 7569 — Punishing Health Care Fraudsters Act

This section increases the maximum term of imprisonment for health care fraud (18 U.S.C. §1347)—which criminalizes schemes to defraud health care benefit programs (e.g., Medicare or private insurers) in connection with the delivery or payment for health care items or services—to 25 years (from 10 years), and to 30 years (from 20 years) if the violation results in serious bodily injury. The amendments apply to conduct occurring on or after the date of enactment.

This section increases criminal penalties under Section 1128B of the Social Security Act (i.e., for fraud, kickbacks, and other prohibited acts involving federal health care programs such as Medicare and Medicaid) as follows: (1) to a maximum fine of $250,000 (from $100,000) wherever it appears; (2) to a maximum term of imprisonment of 25 years (from 10 years) wherever it appears; (3) in subsection (a), to a fine of $100,000 (from $20,000) in the flush matter following paragraph (6); and (4) in subsection (e), to a fine of $100,000 (from $4,000) and a term of imprisonment of 1 year (from six months). The amendments apply to acts occurring and statements or representations made on or after the date of enactment.

This section directs the United States Sentencing Commission, pursuant to 28 U.S.C. 994(p), to review and, if appropriate, amend the federal sentencing guidelines and policy statements applicable to persons convicted of health care fraud offenses (i.e., covered offenses) under 18 U.S.C. 1347 or SSA §1128B (42 U.S.C. 1320a-7b). In doing so, the Commission shall (1) ensure the guidelines reflect the seriousness of covered offenses, their growing incidence, and the need for effective deterrence and punishment; (2) consider factors such as potential and actual loss (including qualitative victim impact), sophistication and planning, commercial or financial motives, intent or effects causing physical, psychological, emotional, or privacy harm, public health or safety threats, and the defendant's role and offense duration; (3) ensure consistency with other guidelines and directives; (4) account for aggravating or mitigating circumstances justifying exceptions to standard ranges; (5) make conforming changes; and (6) meet the purposes of sentencing under 18 U.S.C. 3553(a)(2).