5th Cir. Pattern Jury Instr. (Criminal) 2.50

18 U.S.C. §§ 1035(a)(1), 1035(2)

Title 18 U.S.C. Section 1035, makes it a crime for anyone, in any matter involving a health

care benefit program, to knowingly and willfully (1) falsify, conceal, or cover up by any trick,

scheme, or device a material fact; or (2) make any materially false, fictitious, or fraudulent

statements or representations, or make or use any materially false writing or document knowing

the same to contain any materially false, fictitious, or fraudulent statement or entry, in connection

with the delivery of or payment for health care benefits, items, or services.

For you to find the defendant guilty of this crime, you must be convinced that the

government has proved each of the following beyond a reasonable doubt:

First: That the defendant falsified [concealed] [covered up] a fact by any trick, scheme, or

device;

[First: That the defendant made any false [fictitious] [fraudulent] statement or

representation [made or used any false writing] [made or used any false document] knowing the

same to contain any false, fictitious or fraudulent statement or entry];

Second: That the fact [false, fictitious, or fraud statement or representation] [false writing

or document] was material;

Third: That the defendant did so in connection with the delivery of [payment for] health

care benefits, items, or services involving a health care benefit program; and

Fourth: That the defendant did so knowingly and willfully.

A “health care benefit program” is defined as “any public or private plan or contract,

affecting commerce, under which any medical benefit item, or service is provided to any

individual, and includes any individual or entity who is providing a medical bene fit item, or

service, for which payment may be made under the plan or contract.”

A statement, representation, or entry is “false” if it is known to be untrue or is made with

reckless indifference as to its truth or falsity. A statement, representation, or entry is also “false”

when it constitutes a half-truth, or effectively omits or conceals a material fact, provided it is made

with intent to defraud.

A false statement, representation, or entry is “material” if it has a natural tendency to

influence, or is capable of influencing, the institution to which it is addressed.

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