Determining the Proper Standard of Causation to Support a Conviction Under 18 U.S.C. § 1347 When Healthcare Fraud 'Results in Death

• Author: Laura A. Feldman
• Position: J.D., The University of Iowa College of Law, 2013
• Pages: 2061-2086

2061

Determining the Proper Standard of

Causation to Support a Conviction Under

18 U.S.C. § 1347 When Healthcare Fraud

“Results in Death”

Laura A. Feldman

ABSTRACT: The circuit courts of appeals are currently divided as to the

appropriate standard of causation required by the “results in death”

language of the healthcare-fraud statute, 18 U.S.C. § 1347. Because the

Sixth Circuit’s proximate-cause standard respects fundamental principles of

causation, acknowledges the key distinctions between this statute and

narrower drug statutes, and comports with other courts’ interpretations of

penalty-enhancing statutes, this Note argues that Congress should clarify the

statutory language or the Supreme Court should resolve the matter by

explicitly adopting the Sixth Circuit’s proximate-cause standard.

I. INTRODUCTION .................................................................................... 2063

II. BACKGROUND ...................................................................................... 2063

A. HEALTHCARE FRAUD: CONDUCT AND COSTS .................................... 2064

B. THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT

OF 1996 ........................................................................................ 2066

C. ELEMENTS AND CAUSATION UNDER 18U.S.C. § 1347 ..................... 2069

III. THE CIRCUIT COURT APPROACHES TO THE CAUSATION

REQUIREMENT ..................................................................................... 2071

A. THE SIXTH CIRCUIT’S PROXIMATE-CAUSE STANDARD IN UNITED

STATES V. MARTINEZ .................................................................... 2071

B. THE ELEVENTH CIRCUIT’S CAUSE-IN-FACT STANDARD IN UNITED

STATES V. WEBB ............................................................................ 2074

IV. THE “RESULTS IN DEATH” LANGUAGE IMPLIES A PROXIMATE-CAUSE

STANDARD ............................................................................................ 2077

A. PROBLEMS WITH THE COMPARISON TO 21 U.S.C. § 841(b)(1)(C) .... 2077

* J.D., The University of Iowa College of Law, 2013; M.P.H., The University of Iowa

College of Public Health, 2013; B.A., American University, 2008.

2062 IOWA LAW REVIEW [Vol. 98:2061

1. Inapplicability of a Drug-Statute Framework ..................... 2079

2. Problems with Strict Liability .............................................. 2081

B. A MORE APPROPRIATE COMPARISON: STATUTES WITH “RESULTS IN

DEATH” LANGUAGE THAT REQUIRE PROXIMATE CAUSE ................... 2083

C. POLICY BENEFITS OF PROXIMATE CAUSE .......................................... 2084

V. CONCLUSION ....................................................................................... 2086