Healthcare fraud in the United States of America and Ukraine: A comparative legal research

Abstract

Aim: To conduct a comparative legal study of healthcare fraud in the United States of America and Ukraine. Materials and Methods: This study is based on the analysis of the US federal regulatory legislation (False Claims Act, Anti-Kickback Statute, Stark Law); data from the Fraud Section of the US Department of Justice for the last five years; case law in Ukraine (more than 30 court verdicts were analysed); data from the National Health Service of Ukraine. Dialectical, hermeneutic, comparative, analytical, synthetic, and systems analysis research methods were used. Results: The criminal legislation acts that provide for criminal liability for healthcare fraud under the laws of the United States and Ukraine are analysed; the criteria for identifying types of healthcare fraud and related criminal offences are defined. It is determined that healthcare fraud has a multidimensional nature, which can manifest itself in different ways, but the common purpose in these manifestations of criminal behaviour is deception or intentional distortion of facts to obtain money or property that is under the control of or owned by any healthcare benefit programme (in the US) or medical guarantees programme (in Ukraine). There are various illegal manipulations with the state programme of medical guarantees. Starting from 2021, the judicial practice of Ukraine lacks a single acceptable approach to the criminal legal assessment of such illegal manipulations. Conclusions: The experience of the United States in determining the types of criminal offences that constitute healthcare fraud and establishing criminal liability for their commission is appropriate to borrow.