Summary

Raises criminal penalties for health care fraud and related offenses and directs the U.S. Sentencing Commission to review and update federal sentencing guidelines for those crimes. Specifically, it increases maximum prison terms in the federal health care fraud statute and raises fines and prison terms for offenses involving Federal health care programs, with the changes applying only to conduct after the law takes effect.

Key Points

• Increases federal maximum prison terms for health care fraud: a previous 10‑year max becomes 25 years, and a previous 20‑year max becomes 30 years (applies prospectively).
• Raises fines and maximum prison terms for crimes involving Federal health care programs under the Social Security Act (42 U.S.C. §1320a–7b).
• Requires the U.S. Sentencing Commission to review and, if appropriate, revise sentencing guidelines and policy statements for health care fraud and related offenses.
• Sentencing Commission must consider specific aggravating/mitigating factors (harm, privacy breaches, intent, sophistication, duration, role, cooperation).
• Penalty increases apply only to conduct occurring on or after the law’s enactment (no retroactive increase in punishment).
• No new appropriations or emergency funding specified; administrative costs may rise for enforcement, prosecutions, and guideline revisions.
• May affect charging, plea bargaining, and sentencing outcomes—especially in large-scale, sophisticated, or privacy‑involving fraud schemes.
• Targets providers, suppliers, billing agents, beneficiaries who commit criminal offenses, as well as prosecutors, defense attorneys, and courts.

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