Criminal Law

- In a criminal case, a X is the plaintiff. State v. defendant's name. Brought by X that have unlimited discretion on what cases should be brought, that does not mean the person is X just because they are charged, we have the presumption of X until proven guilty. 

- In a criminal law a X will bring a prosecution, the prosecutor can X to prosecute. X will have the right to have evidence brought, to have witnesses attend, to confront witnesses with cross examination, and to have X evidence (evidence that will show that the defendant is X, cases have been overturned because prosecutors failed to give X evidence the way it was supposed to be done) given to them by the prosecutor  

- In criminal law, X matters. If you do something to harm someone intentionally the penalty will be more than if you were just being reckless. If you intended to run someone down with your car, however, if you were drinking and you hit someone but you didn’t mean to do it. The Law punishes people more for something they did on X rather than being X. Although penalties for reckless behavior can still be high. If you do something by accident there could just be civil liabilities and not criminal law liabilities.

- In a criminal case, a state is the plaintiff. State v. defendant's name. Brought by prosecutors that have unlimited discretion on what cases should be brought, that does not mean the person is guilty just because they are charged, we have the presumption of innocence until proven guilty. 

- In a criminal law a state will bring a prosecution, the prosecutor can decline to prosecute. Defendants will have the right to have evidence brought, to have witnesses attend, to confront witnesses with cross examination, and to have exculpatory evidence (evidence that will show that the defendant is innocent, cases have been overturned because prosecutors failed to give exculpatory evidence the way it was supposed to be done) given to them by the prosecutor  

- In criminal law, intent matters. If you do something to harm someone intentionally the penalty will be more than if you were just being reckless. If you intended to run someone down with your car, however, if you were drinking and you hit someone but you didn’t mean to do it. The Law punishes people more for something they did on purpose rather than being reckless. Although penalties for reckless behavior can still be high. If you do something by accident there could just be civil liabilities and not criminal law liabilities.

-Crime is defined as “any act which the sovereign has deemed X to the public X; a wrong which the X has determined is X to the public and, hence, X in a criminal proceeding.”

-Misdemeanors or felonies, based on X. X (petty larceny): less than 1 year in jail and/or a fine.  A X is a serious crime (e.g., rape, murder) and is punishable by imprisonment in a X or X penitentiary for more than 1 year. 

- Criminal law: X of people in relation to X norms, whereas civil law is relationships between X individuals and their X/X under the law.

- X-tolerance policy for healthcare fraud, patient abuse, etc.

- After being arrested: X or X on bond. If a felony, the U.S. X requires a X X for an X: evidence presented by a X to determine if there is X cause to believe a X has been committed, not to decide X or X. If the grand jury finds, they issue an X. An X begins a criminal proceeding. An indictment is the official X instrument accusing the X of criminal conduct.

-Crime is defined as “any act which the sovereign has deemed contrary to the public good; a wrong which the government has determined is injurious to the public and, hence, prosecutable in a criminal proceeding.”

-Misdemeanors or felonies, based on severity. Misdemeanor (petty larceny): less than 1 year in jail and/or a fine.  A felony is a serious crime (e.g., rape, murder) and is punishable by imprisonment in a state or federal penitentiary for more than 1 year. 

- Criminal law: behavior of people in relation to societal norms, whereas civil law is relationships between private individuals and their rights/obligations under the law.

- Zero-tolerance policy for healthcare fraud, patient abuse, etc.

- After being arrested: detained or released on bond. If a felony, the U.S. The Constitution requires a grand jury for an indictment: evidence presented by a prosecutor to determine if there is probable cause to believe a crime has been committed, not to decide guilt or innocence. If the grand jury finds, they issue an indictment. An indictment begins a criminal proceeding. An indictment is the official charging instrument accusing the defendant of criminal conduct.

- X reps state, X reps the defendant. In virtually every jurisdiction, unless a X plea, there is a X. X spell out what is a criminal act. The X has to prove all the elements, if they didn’t the defendant is not guilty.

In a case three things are established: 1.  The act itself is a X act, known as X X or the X act. 2. The intent to commit the criminal act provides the X X state, or the X X. 3. The attendant or surrounding X of the crime demonstrate that the crime was committed by the X. 

- Arraignment is a X reading of the X instrument (variety of X, each of which accuses the X of an offense) and includes the X of X. 

- A not guilty plea is normally offered on a X complaint. On a plea of not guilty, the defense attorney and prosecutor argue to the X when X X. After X, judge sets a date to X to X. 

- Plead guilty: will have a X X hearing. Does not plead guilty, taken to X, and

plea-X happens with the goal of an X. If cannot be reached, the case is X, more plea-bargaining takes place later. After several X, and no agreement, a case will simply be assigned to a X X

- A trial includes X selection, opening X, X presentation, suXs, X instructions, deX, veX, and possible X. In criminal trials, the jury must reach a X verdict and guilt must be proven beyond a X doubt; in civil trials, the plaintiff wins by a X of the evidence.

- Prosecutor reps state, defendant reps the defendant. In virtually every jurisdiction, unless a guilty plea, there is a trial. Statutes spell out what is a criminal act. The prosecutor has to prove all the elements, if they didn’t the defendant is not guilty.

In a case three things are established: 1.  The act itself is a criminal act, known as actus reus or the guilty act. 2. The intent to commit the criminal act provides the requisite mental state, or the mens rea. 3. The attendant or surrounding circumstances of the crime demonstrate that the crime was committed by the defendant. 

- Arraignment is a formal reading of the accusatory instrument (variety of documents, each of which accuses the defendant of an offense) and includes the setting of bail. 

- A not guilty plea is normally offered on a felony complaint. On a plea of not guilty, the defense attorney and prosecutor argue to the judge when setting bail. After arraignment, judge sets a date to return to court. 

- Plead guilty: will have a grand jury hearing. Does not plead guilty, taken to conference, and

plea-bargaining happens with the goal of an agreement. If cannot be reached, the case is adjourned, more plea-bargaining takes place later. After several adjournments, and no agreement, a case will simply be assigned to a trial court

- A trial includes jury selection, opening statements, evidence presentation, summations, jury instructions, deliberation, verdict, and possible appeal. In criminal trials, the jury must reach a unanimous verdict and guilt must be proven beyond a reasonable doubt; in civil trials, the plaintiff wins by a preponderance of the evidence.

- A prosecutor doesn’t act like an ordinary party trying to X. Instead, their duty is to ensure X, making sure the X are punished and the X are protected. They serve the X, not just their side.

- Healthcare fraud: X for personal X. Financial drain on healthcare. X is main investigates federal and private X programs healthcare X, they partner with other X. 

- X has criminal and civil enforcement to combat healthcare fraud. It requires the X X and X Secretary, through the X, to run a national healthcare X and X control program. The X-X prevents X, X, and X in X. 

- X X Sessions and X Secretary Price announced the largest Medicare Fraud Strike Force. The government charged hundreds of medical workers for X fraud and illegal X use and suspended nearly # providers to stop abuse and protect X.

- HEAT (2009): Created by X and X to make X fraud a X-level priority; directed by X Secretary and X General.

- 2015 HEAT achievement: Coordinated a national healthcare fraud takedown uncovering $712 million in fraudulent X.

- Medicare Fraud Strike Force: Multiagency team targeting Medicare fraud, which costs the U.S. $# billion annually.

- 2011 Strike Force success: Charged # defendants, including medical professionals and executives, foX $# million in false billing.

- 2012 X-x partnership: Collaboration between government, private insurers, and antifraud groups to share information and prevent healthcare fraud.

- A prosecutor doesn’t act like an ordinary party trying to win. Instead, their duty is to ensure justice, making sure the guilty are punished and the innocent are protected. They serve the law, not just their side.

- Healthcare fraud deception for personal gain. Financial drain on the healthcare. FBI is main investigates federal and private insurance programs healthcare fraud, they partner with other agenies. 

- HIPAA has criminal and civil enforcement to combat healthcare fraud. It requires the Attorney General and HHS Secretary, through the OIG, to run a national healthcare fraud and abuse control program. The HHS-OIG prevents fraud, waste, and abuse in Medicare. 

- Attorney General Sessions and HHS Secretary Price announced the largest Medicare Fraud Strike Force. The government charged hundreds of medical workers for Medicare fraud and illegal opioid use and suspended nearly 300 providers to stop abuse and protect patients.

- HEAT (2009): Created by DHHS and DOJ to make Medicare fraud a Cabinet-level priority; directed by HHS Secretary and Attorney General.

- 2015 HEAT achievement: Coordinated a national healthcare fraud takedown uncovering $712 million in fraudulent billing.

- Medicare Fraud Strike Force: Multiagency team targeting Medicare fraud, which costs the U.S. $80 billion annually.

- 2011 Strike Force success: Charged 111 defendants, including medical professionals and executives, for $225 million in false billing.

- 2012 public-private partnership: Collaboration between government, private insurers, and antifraud groups to share information and prevent healthcare fraud.

X government made X X Programs: 

- Develop X 

- Appoint a X officer to oversee the compliance program

- Communicate the organization’s compliance program to X

- Implement X and X systems to detect X conduct by employees and agents

- Publicize a X system for employees and agents to report X conduct without fear of X

- Take appropriate steps to respond to X conduct and prevent similar offenses

- Periodically X and X the corporate compliance program

- Collaborate with X and X law enforcement, regulatory X, and X companies to detect, prevent, and prosecute healthcare fraud

Scheme to defraud: X someone out of X or X. To prove it, you need to show:

- The defendant engaged in a X, X scheme.

- They acted with X to cheat more than one person or take property through X or X promises.

- They actually obtained X from at least one person as a result of the scheme.

Healthcare fraud: when a provider or patient X/ x information to get more healthcare X or X.

- X for services not actually done

- X a diagnosis to justify unnecessary X or x

- Misrepresenting procedures to get X for X services

- X (billing for more expensive services or equipment than used)

- X (billing parts of a procedure separately to get more money)

- Providing X services

- Taking X for patient referrals

- Waiving patient X-X or X improperly

- X insurance or benefit plans

Federal government made Corporate Compliance Programs: 

- Develop policies 

- Appoint a compliance officer to oversee the compliance program

- Communicate the organization’s compliance program to employees

- Implement monitoring and auditing systems to detect criminal conduct by employees and agents

- Publicize a reporting system for employees and agents to report criminal conduct without fear of retribution

- Take appropriate steps to respond to criminal conduct and prevent similar offenses

- Periodically review and update the corporate compliance program

- Collaborate with state and federal law enforcement, regulatory agencies, and insurance companies to detect, prevent, and prosecute healthcare fraud

Scheme to defraud: cheat someone out of money or property. To prove it, you need to show:

- The defendant engaged in a systematic, ongoing scheme.

- They acted with intent to cheat more than one person or take property through lies or false promises.

- They actually obtained property from at least one person as a result of the scheme.

Healthcare fraud: when a provider or patient lies/ false information to get more healthcare benefits or payments.

- Billing for services not actually done

- Faking a diagnosis to justify unnecessary tests or procedures

- Misrepresenting procedures to get payment for noncovered services

- Upcoding (billing for more expensive services or equipment than used)

- Unbundling (billing parts of a procedure separately to get more money)

- Providing unnecessary services

- Taking kickbacks for patient referrals

- Waiving patient co-pays or deductibles improperly

- Overbilling insurance or benefit plans

Home care fraud is hard to X, when providers cheat insurers by:

Charging for more X than actually given, X for more hours of care than provided, Faking records, Charging higher X rates for care actually done by aides

- Physician self-referral fraud happens when doctors send patients to hospitals or services they have a X X in. Studies showed this leads to more X tests. Laws and ethical rules, including the X and X X Act (1989) and X guidelines, now X most X-X.The ethical risks inherent in physician self-referral were first noted in a 1986 X of X study, X House of Delegates voted to declare self-referral X in most instances. The X X X Act banned physicians from referring X patients to X they or their family members had a financial interest in. Expanded this to # more health services, including theX, radiX, medX equipment, hX health, and prX X, and also applied the rules to MX. 

- The Anti-Kickback Statute (part of the X and X X Protection Act of 1987) makes it a crime to oXr, pX, X for, or X anything of value in exchange for patient X or for recommending or ordering services, goods, or facilities that are paid for by X or X. Anyone who breaks this law can face X charges or be banned from X and X. The government especially watches for these false billing practices: Charging for X not actually given, X for patients who aren’t truly X, Claiming X that never happened, Billing for visits without a X approval. 

- The U.S. X of X ruled that taking a kickback counts as an act to block the X lawful work, which is a X crime. Conspiring to defraud the U.S. can mean cheating it out of money or interfering with its duties through lies or trickery.

Home care fraud is hard to detect, when providers cheat insurers by:

Charging for more services than actually given, Billing for more hours of care than provided, Faking records, Charging higher nurse rates for care actually done by aides

- Physician self-referral fraud happens when doctors send patients to hospitals or services they have a financial interest in. Studies showed this leads to more unnecessary tests. Laws and ethical rules, including the Ethics and Patient Referrals Act (1989) and AMA guidelines, now prohibit most self-referrals.The ethical risks inherent in physician self-referral were first noted in a 1986 Institute of Medicine study, AMA House of Delegates voted to declare self-referral unethical in most instances. The Omnibus Budget Reconciliation Act banned physicians from referring Medicare patients to labs they or their family members had a financial interest in. Expanded this to 10 more health services, including therapy, radiology, medical equipment, home health, and prescription drugs, and also applied the rules to Medicaid. 

- The Anti-Kickback Statute (part of the Medicare and Medicaid Patient Protection Act of 1987) makes it a crime to offer, pay, ask for, or receive anything of value in exchange for patient referrals or for recommending or ordering services, goods, or facilities that are paid for by Medicare or Medicaid. Anyone who breaks this law can face criminal charges or be banned from Medicare and Medicaid. The government especially watches for these false billing practices: Charging for services not actually given, Billing for patients who aren’t truly homebound, Claiming visits that never happened, Billing for visits without a doctor’s approval. 

- The U.S. Court of Appeals ruled that taking a kickback counts as an act to block the government’s lawful work, which is a federal crime. Conspiring to defraud the U.S. can mean cheating it out of money or interfering with its duties through lies or trickery.

- Assault is the threat of X, being in someone’s face, making them X that you are going to hurt them. 

- Theft, e.g., a X could steal from a hospital. Theft of patient or employer property

- Fraud, billing fraud and insurance fraud is a X. Serious crimes and they are prosecuted. 

- Federal law (21 U.S.C. § 841(a)) makes it a crime to:

Make, sell, give out, or hold with intent to make or sell a X X.

Make, sell, give out, or hold with intent to sell a X X.

The X warns that most X pharmacies are fake and often sell counterfeit drugs.

These drugs may be X, X, have the wrong X or no medicine at all, or contain dangerous X.

Taking them can make you sick, cause bad reactions, or stop real medicine from working.

If healthcare providers illegally sell X X, they can face X charges and lose their medical X. Both the X who writes an illegal prescription and any X who knowingly fills it can be punished.

Anyone harmed by the false X can sue, and the provider could lose X and X funding.

Patient abuse is mistreating or neglecting someone under healthcare, whether in a X or at X.

It can be X, X, X, or X. X is often hard to spot, especially in X patients, because injuries may look like X health problems.

Hospital patients are usually there X and are less X on staff, so long-term abuse is X likely. Nursing home residents, who rely on staff for years, face a X risk.

X abuse is widespread in society. A national study found that about # of all homes experience family violence at least once a year.

It’s hard to know how much elder abuse happens because many older people don’t X abuse by family or loved ones.

- Assault is the threat of battery, being in someone’s face, making them afraid that you are going to hurt them. 

- Voluntary manslaughter, surgeon is drunk and patient killed someone, they were reckless, unintentionally killed someone

- Theft, e.g., a vendor could steal from a hospital. Theft of patient or employer property

- Fraud, billing fraud and insurance fraud is a crime. Serious crimes and they are prosecuted. For example, not providing all of the services you can be sued for fraud.

- Federal law (21 U.S.C. § 841(a)) makes it a crime to:

Make, sell, give out, or hold with intent to make or sell a controlled drug.

Make, sell, give out, or hold with intent to sell a fake drug.

The FDA warns that most online pharmacies are fake and often sell counterfeit drugs.

These drugs may be expired, contaminated, have the wrong dose or no medicine at all, or contain dangerous ingredients.

Taking them can make you sick, cause bad reactions, or stop real medicine from working.

If healthcare providers illegally sell prescription drugs, they can face criminal charges and lose their medical licenses. Both the doctor who writes an illegal prescription and any pharmacist who knowingly fills it can be punished.

Faking medical or business records is a crime.

Anyone harmed by the false records can sue, and the provider could lose Medicare and Medicaid funding.

Patient abuse is mistreating or neglecting someone under healthcare, whether in a facility or at home.

It can be physical, psychological, medical, or financial. Abuse is often hard to spot, especially in elderly patients, because injuries may look like normal health problems.

Hospital patients are usually there briefly and are less dependent on staff, so long-term abuse is less likely. Nursing home residents, who rely on staff for years, face a higher risk.

Elder abuse is widespread in society. A national study found that about half of all homes experience family violence at least once a year.

It’s hard to know how much elder abuse happens because many older people don’t report abuse by family or loved ones.

Abuse in nursing homes led to stronger resident rights under the X X X Act of 1989, which says residents must be free from X, X, X, or X abuse, X punishment, and forced X.

Despite stronger laws, abuse still happens. 

X X is when someone carelessly ignores the safety of others and shows no concern for possible harm their actions might cause. Criminal negligence happens when someone’s X is so extreme that it goes far below what a reasonably careful person would do in the same situation. It’s more serious than ordinary carelessness and is sometimes called X negligence or X in the law.

Manslaughter is causing someone’s X without X to. It can be:

Voluntary manslaughter: Killing intentionally but without X, often in the “X of passion” after being X (e.g., catching a spouse in an affair).

Involuntary manslaughter: Causing death by acting X or X, without X to kill (e.g., doing a risky surgery without the necessary skill).

Since 1990, more doctors have been prosecuted for X, but few are actually X.

Most cases aren’t about intentional rule-breaking—they’re often due to X mistakes or lapses.

Prosecuting individuals rarely makes patients X; improving X systems is what really reduces errors.

Abuse in nursing homes led to stronger resident rights under the Omnibus Budget Reconciliation Act of 1989, which says residents must be free from verbal, sexual, physical, or mental abuse, corporal punishment, and forced isolation.

Despite stronger laws, abuse still happens. For example, a nurse’s aide was jailed for punching a 91-year-old patient and had prior abuse convictions.

Criminal negligence is when someone carelessly ignores the safety of others and shows no concern for possible harm their actions might cause. Criminal negligence happens when someone’s carelessness is so extreme that it goes far below what a reasonably careful person would do in the same situation. It’s more serious than ordinary carelessness and is sometimes called gross negligence or recklessness in the law.

Manslaughter is causing someone’s death without intending to. It can be:

Voluntary manslaughter: Killing intentionally but without planning, often in the “heat of passion” after being provoked (e.g., catching a spouse in an affair).

Involuntary manslaughter: Causing death by acting negligently or recklessly, without intending to kill (e.g., doing a risky surgery without the necessary skill).

Since 1990, more doctors have been prosecuted for manslaughter, but few are actually convicted.

Most cases aren’t about intentional rule-breaking—they’re often due to human mistakes or lapses.

Prosecuting individuals rarely makes patients safer; improving healthcare systems is what really reduces errors.

- Statutory rape is when someone has sex with a person who is below the legal X of consent.

When a hospital handles a possible rape case, it must:

Notify parents if the patient is a X

Report to law X quickly

X the patient following proper procedures

Collect and protect X (e.g., body fluids)

X thoroughly (photos, victim statements)

Treat X

Maintain X and X

Provide X support

Refer for follow-up X

Offer X counseling if needed

Medical steps (per ACOG):

Get X X

Treat X and assess medical X

Conduct X and X exams with a X

Collect X and test for X

Give X prevention or emergency X if needed

Discuss X, x, and x

Arrange X-up care and X support

Legal steps:

X events accurately

X injuries

Collect X following rules

Check for X and make slides if needed

X to authorities as required

Keep evidence X and maintain chain of X

- Statutory rape is when someone has sex with a person who is below the legal age of consent.

When a hospital handles a possible rape case, it must:

For all patients:

Notify parents if the patient is a minor

Report to law enforcement quickly

Examine the patient following proper procedures

Collect and protect evidence (e.g., body fluids)

Document thoroughly (photos, victim statements)

Treat injuries

Maintain privacy and dignity

Provide emotional support

Refer for follow-up counseling

Offer pregnancy counseling if needed

Medical steps (per ACOG):

Get informed consent

Treat injuries and assess medical history

Conduct physical and pelvic exams with a chaperone

Collect specimens and test for STIs

Give infection prevention or emergency contraception if needed

Discuss findings, recommendations, and prognosis

Arrange follow-up care and psychosocial support

Legal steps:

Record events accurately

Document injuries

Collect samples following rules

Check for sperm and make slides if needed

Report to authorities as required

Keep evidence secure and maintain chain of custody

Theft is illegally taking someone else’s X.

The cost of theft in X is very X, totaling millions of dollars each year.

Medical X theft is when someone uses another person’s personal or insurance information without permission to get medical care, prescription drugs, surgery, or to submit false insurance claims. Thieves may steal information from mail, bills, or bank statements to commit X.

To help protect patients and improve healthcare, X set rules for electronic health transactions, unique health IDs, and security. It also requires X privacy protections to keep personal health information safe.

When a breach of protected health information occurs, the Department of X and X X (DHHS) requires:

X Notice – Send affected people a X letter or email (if they agreed to electronic notices).

X Notice – Alert the X if more than # people in a state or area are affected.

Notice to X – Inform the X in addition to notifying individuals and the media.

The X provides a brochure called X X X on its website, which helps people:

X identity theft

Correct X in medical records

X their medical information

Check for other identity theft X

It also lists X info for X reporting companies.

One of the most tempting crimes for healthcare workers is X or X dX, which can be very X if sold or given to the wrong people.

Theft is illegally taking someone else’s property.

The cost of theft in healthcare is very high, totaling millions of dollars each year.

Medical identity theft is when someone uses another person’s personal or insurance information without permission to get medical care, prescription drugs, surgery, or to submit false insurance claims. Thieves may steal information from mail, bills, or bank statements to commit fraud.

To help protect patients and improve healthcare, HIPAA set rules for electronic health transactions, unique health IDs, and security. It also requires federal privacy protections to keep personal health information safe.

When a breach of protected health information occurs, the Department of Health and Human Services (DHHS) requires:

Individual Notice – Send affected people a written letter or email (if they agreed to electronic notices).

Media Notice – Alert the public if more than 500 people in a state or area are affected.

Notice to DHHS – Inform the Secretary in addition to notifying individuals and the media.

The FTC provides a brochure called Medical Identity Theft on its website, which helps people:

Detect identity theft

Correct errors in medical records

Protect their medical information

Check for other identity theft issues

It also lists contact info for credit reporting companies.

One of the most tempting crimes for healthcare workers is stealing or misusing drugs, which can be very profitable if sold or given to the wrong people.

The objectives of criminal law are to:

Maintain public X and X

X individuals

Use X as a X to crime

X criminals for return to society

A crime—a social X defined and made X by law—is generally either a X or a X.

A X is an offense generally punishable by less than 1 year in jail and/or a fine.

A X, however, is punishable by imprisonment in a state or federal prison for a period of

more than 1 year.

Criminal procedure involves

-AX

-AX

-IX

-CX

-CX X

The objectives of criminal law are to:

Maintain public order and safety

Protect individuals

Use punishment as a deterrent to crime

Rehabilitate criminals for return to society

A crime—a social harm defined and made punishable by law—is generally either a misdemeanor or a felony.

A misdemeanor is an offense generally punishable by less than 1 year in jail and/or a fine.

A felony, however, is punishable by imprisonment in a state or federal prison for a period of

more than 1 year.

Criminal procedure involves

-Arrest

-Arraignment

-Indictment

-Conference

-Criminal trial