Saturday, December 30, 2006

Third Circuit Reverses Health Care Fraud Conviction

The Third Circuit Court of Appeals reversed a health care fraud conviction providing an important interpretation of 18 U.S.C. s 1347(2).  The court held that the government had failed to establish the elements of the statute because it failed to show that the accused had "used false or fraudulent pretenses, representations, or promises to obtain money or property from Progressive in connection with the delivery of, or payment for, health care benefits, items, or services."  The court makes a clear distinction between what constitutes theft and fraud. The court states:

"Under the common law and the Model Penal Code, theft is synonymous to larceny – the taking of another’s property by trespass with intent to deprive permanently the owner of the property. Id. at 171. Fraud, which did not exist at common law, "means to cheat or wrongfully deprive another of his property by deception or artifice," id. at 178 (quoting United States v. Thomas, 315 F.3d 190, 200 (3d Cir. 2002)), and "implies deceit, deception, artifice, trickery," id. at 177 (citations and quotations omitted)."

The Decision

(esp)(w/ a hat tip to Peter Goldberger)

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