OPINION OF THE COURT
Ruth Whited appeals from the District Court’s order sentencing her to prison and requiring her to make restitution for embezzling from a health care provider in violation of 18 U.S.C. § 669. Whited challenges the sufficiency of the charging indictment and the District Court’s jurisdiction to adjudicate the charge as set forth therein. She also contends that the Commerce Clause does not grant Congress the power to criminalize her actions, and that 18 U.S.C. § 669 is thus unconstitutional as applied to the facts of her case. We note *261 that we are the first court to address the constitutionality of this statute as an exercise of Congress’ power under the Commerce Clause. We agree with the District Court that Whited’s indictment sufficiently alleged the material elements of the offense and that her conviction withstands constitutionаl scrutiny, and will affirm.
I.
The relevant facts are not in dispute and may be briefly recounted. As a receptionist for the Back Mountain Chiropractic Center (“the Center”), Whited was responsible for receiving payment from Center patients. It was common practice for patients to pay by endorsing a check from their insurance provider, Blue Cross of Northeastern Pennsylvania (“Blue Cross”), to the Center. During 1996 and 1997, Whited deposited over fifty of those checks into her personal account, totaling over $34,000.
In early 2001, Whited was charged by indictment of one count of theft or embezzlement in connection with health care, in violation of 18 U.S.C. § 669. That provision provides, in relevant part:
Whoever knowingly and willfully embezzles, steals, or otherwise without authority converts to the use of any pеrson other than the rightful owner, or intentionally misapplies any of the moneys, funds, securities, premiums, credits, property, or other assets of a health care benefit program, shall be fined under this title or imprisoned not more than 10 years, or both....
18 U.S.C. § 669.
The term “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 benefit, item, or service for which payment may be made under the plan or contract.
Id. § 24(b).
The government’s indictment charged: That from on or about November 1996 and continuing up to and including on or about November 1997, in the Middle District of Pennsylvania, the Defendant, Ruth Whited, knowing and willfully embezzled, stole or otherwise without authority converted to the use оf any person other than the rightful owner, or intentionally misapplied any of the monies, funds, securities, premiums, credits, property or other assets of a health care benefit program to wit: approximately $5,956.52 of subscriber checks from Blue Cross of Northeastern Pennsylvania, a health care benefit program within the meaning of 18 United States Code Section 24(b), which checks rightfully belonged to the Back Mountain Chiropractic Center located in Dallas, Pennsylvania. 1
Whited originally pled not guilty, and subsequently filed a motion to dismiss the indictment. She argued that the indictment was insufficient because, although she admitted she stole checks from the Center, the indictment appeared to charge that Blue Cross, rather than the Center, was the victim “health care benefit program.” Further, she urged that Congress did not have the authority to criminalize embezzlement from individual medical care providers such as the Center. After the District Court denied the motion, Whited *262 withdrew her original plea and pled guilty to the indictment. She was sentenced in January, 2002, and this timely appeal followed.
On appeal, Whited reiterates the challenges to the indictment she made in the District Court. First, she argues that the indictment does not allege an essential element of § 669, the theft or embezzlement from a “health care benefit program.” In her view, the indictment refers to subscriber checks from Blue Cross, not the Center. She also contends that' the Center is not a “health care benefit program” as defined in the statute. Thus, she asserts, the District Court lacked subject matter jurisdiction to adjudicate this matter because Congress did not criminalize embezzlement from a mere medical care provider such as a chiropractor. Finally, Waited arg-ues that § 669 is unconstitutional as applied to this case. She admits to embezzlement from the Center, a medical care provider, but argues that Congress is without the authority under the Commerce Clause to criminalize that behavior because her theft from the Center lacked the requisite relation to interstate commerce.
The District Court exercised jurisdiction to determine the sufficiency of the indictment and interpret the relevant statutes pursuant to 18 U.S.C. § 3231, and we have jurisdiction under 28 U.S.C. § 1291. Although Wdiited did not preserve her right to appeal the pretrial motion by entering a conditional guilty plea, see Fed. R.Crim.P. 11(a)(2), all of the issues presented here properly fall within the narrow scope of review not barred by a guilty plea.
See United States v. Rodia,
II.
Preliminarily, Whited argues that the indictment against her was insufficient because it failed to allege an essential element of the crime, and that the District Court was without subject matter jurisdiction to adjudicate the matter as set forth in the indictment. We find little merit to these arguments, and will treat them only briefly.
A.
We exercise plenary review over Whited’s challenge to the sufficiеncy of the indictment.
See Virgin Islands v. Moolenaar,
We consider an indictment sufficient if, when considered in its entirety, it adequately informs the defendant of the charges against her such that she may prepare a defense and invoke the double jeopardy clause when appropriate.
See, e.g., United States v. Stansfield,
Whited’s argument hinges on the unfortunate fact that the indictment says *263 both too much and too little. Because Blue Cross was not the entity defrauded by Whited, whether or not Blue Cross is a health care benefit program under 24(b) was entirely irrelevant, and the indictment’s identification of Blue Cross as a qualifying program was thus entirely superfluous. But because the indictment did identify Blue Cross as a health care benefit program under 24(b), the indictment was problematic in that it did not similarly identify the Center as a qualifying program.
Despite this carelessness in language, the facts alleged do amount to a crime under 669. Again, the indictment reads, in relevant part:
[T]he Defendant, Ruth Whited, knowing and willfully embezzled, stole or otherwise without authority converted to the use of any person other than the rightful owner, or intentionally misapplied any of the monies, funds, securities, premiums, credits, property or other assets of a health care benefit program to wit: approximately $5,956.52 of subscriber checks from Blue Cross of Northeastern Pennsylvania, a health care benefit program within the meaning of 18 United States Code Section 24(b), which checks rightfully belonged to the Back Mountain Chiropractic Center located in Dallas, Pennsylvania.
The indictment clearly states that the checks at issue “belonged to” the Center, and that the theft was from a health care benefit program. The Center is thus identified as a health care benefit program by implication. As we discuss below, the Center is in fact a qualifying “health care benefit program” because it is an “individual or entity who is providing a medical benefit, item, or service for which payment may be made under [a qualifying health care] plan or contract.” 18 U.S.C. § 24(b). Consequently, when considered in its entirety the indictment’s charge — thаt there was a theft from a health care benefit program of subscriber checks belonging to the Center — suffered from no material omissions, sufficiently apprised Whited of the charges against her, and would enable her to invoke the bar of double jeopardy if necessary.
See Turley,
B.
In the alternative, Whited contends that the Center is not a qualifying health care benefit program at all, and that consequently the District Court was without subject matter jurisdiction because the general theft or embezzlement from a medical care provider is not a federal crime. We disagree.
Our review over matters of statutory interpretation is plenary, and our role is limited to effectuating the intent of Congress.
Rosenberg v. XM Ventures,
[T]he term “health care benefit program” means 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 benefit, item, or ■service for which payment may be made under the plan or contract.
18 U.S.C. § 24(b) (emphasis’ added).
The Center is a local provider of chiropractic services, and even Whited concedes that payment is made for those services through Blue Cross, which is undisputably a health care benefit program. Section 24(b) explicitly “includes” precisely those types of local medicаl service providers. The statute thus makes clear Congress’s intent to criminalize theft or embezzlement under 18 U.S.C. § 669 when the victim of that theft or embezzlement is a medical services provider — such as the Center-— being compensated pursuant to a public or private plan, such as Blue Cross.
Despite the clarity of the statute’s plain language, Whited invokes certain portions of the statute’s legislative history in arguing that Congress did not intend to criminalize theft from a local medical service provider. Where a statute is “plain and unambiguous” on its face, however, further inquiry into legislative intent is unnecessary.
Rosenberg,
III.
Having concluded that neither of Whited’s arguments relating to her particular indictment have merit, we turn to Whited’s constitutional challenge to her prosecution for a federal offense. Whited argues that authorizing the prosecution of individuals like herself who have simply stolen from local medical service providers exceeds the limited powers vested in Cоngress under the Commerce Clause. Thus, Whited argues, 18 U.S.C. § 669 is unconstitutional insofar as it was applied here.
The District Court disagreed. After noting that we are to accord deference to Congressional determinations that particular legislation is within its constitutional authority, the District Court wrote:
[T]he United States correctly points out that a payer such as Blue Cross of Northeastern Pennsylvania made payments to Back Mountain under a contract with its subscriber under a health care program which Congress has deemed appropriate to regulate as an economic and commercial enterprise which affects interstate commerce by prohibiting fraud.
United States v. Whited, No. CR-01-0008, slip op. at 4 (M.D.Pa. May 12, 2001).
In its opinion, the District Court emphasized the interstate nature of the commercial enterprises and contractual relationships through which the payment for
*265
health care services is made. Ultimately, although reiterating its view that Congressional authority under the Commerce Clause is and should be limited, it held that Congress was within the appropriate scope of its power in criminalizing the actions at issue here. We exercise plenary review of the District Court’s determination of the statute’s constitutionality,
United States v. Singletary,
A.
We are presented once again with the difficult and delicate task of determining whether Congress has exceeded its authority “[t]o regulate Commerce ... among the several States,” U.S. Const, art I, § 8, cl. 3, an issue that is now commonplace in our courts as a result of the Supreme Court’s ruling in
United States v. Lopez,
The Court reiterated that laws regulating intrastate economic activity have been upheld against Commerce Clause challenges where the underlying intrastate “economic activity substantially affects interstate commerce,” or where the law regulates “activities that arise out of or are connected with a commercial transaction, which viewed in the aggregate, substantially affects interstate commerce.”
Id.
at 560-61,
By contrast, the Gun-Free School Zones Act on its face criminalized an action — gun possession near a school — that is wholly unrelated to “ ‘commerce’ or any sort of economic enterprise, however broadly one might define those terms.”
Lopez,
The Court further took note of two additional factors. First, the Act did not contain an “express jurisdictional element” that would limit its application to particular instances in which the “firearm possession ] ... ha[d] an explicit connection with or effect on interstate commerce.”
Id.
at 561-62,
Ultimately, the
Lopez
Court was unpersuaded by the proffered nexus between gun possession near schools and interstate commerce, the theory “that possession of a firearm in a school zone may result in violent crime and that violent crime can be expected to affect the functioning of the national economy.”
Id.
at 563,
Five years later the Court struck down the Violence Against Women Act (“VAWA”) in
United States v. Morrison,
The
Morrison
Court also followed the
Lopez
Court in taking note of the lack of a “jurisdictional element” in the VAWA, and in considering the presence or absence of congressional findings.
Id.
at 613,
B.
At the outset, we note that our analysis is to be conducted with the understanding that congressional acts are entitled to a “presumption of constitutionality,” and will only be invalidated upon a “plain showing that Congress has exceeded its constitutional bounds.”
Id.
at 607,
Like the statutes considered in Lopez and Morrison, 18 U.S.C. § 669 is properly analyzed as an attempt by Congress to regulate within the third category of its powers as enumerated by the Court — those activities that are substantially related to interstate commerce. As suggested in our discussion above, there are four considerations relevant to the determinаtion of whether a particular law regulates activity that has a substantial effect on interstate commerce:
1) the economic nature of the regulated activity; 2) a jurisdictional element limiting the reach of the law to a discrete set of activities that additionally has an explicit connection with or effect on interstate commerce; 3) express congressional findings regarding the effects upon interstate commerce of the activity in question; and 4) the link between the regulated activity and interstate commerce.
Gregg,
We conclude that, unlike the statutes considered in Lopez and Morrison, Congress had a rational basis for believing that § 669 regulates distinctly economic activity bearing a clear and significant relation to interstate commerce. Accordingly, we hold that Congress’s criminalization of the activity in question here was a proper exercise of Congress’s Commerce Clause authority.
1. The Economic Nature of the Regulated Activity
The first stage of our Commerce Clause analysis is an inquiry into the fundamental character of the activity being regulated. Our recent decisions in this area reflect the importance of the initial inquiry into the character of the underlying activity, and illustrate the crucial distinction between real economic activity and the fundamentally noneconomic activity at issue in
Lopez
and
Morrison.
Most recently, in
United States v. Spinello,
Here, following these precedents, we can readily conclude that the activity regulated by § 669 — theft in connection with health care — is economic in nature. The theft itself is motivated exclusively by an immediate pecuniary gain,
see Spinello,
2. The Presence of a Jurisdictional Element
The presence or absence of a jurisdictional element limiting the statute’s scope to those cases with “an explicit connection with or effect on interstate commerce,” is a second important factor in the constitutional analysis.
Morrison,
The statute at issue here does benefit from the existence of a jurisdictional element. In relevаnt part, § 669 criminalizes theft from a health care benefit program, the definition of which is explicitly qualified with the phrase “affecting commerce.” 18 U.S.C. § 24(b). Section 669 therefore criminalizes only thefts from health care plans or contracts — or medical providers under those plans or contracts — that affect commerce.
See Jones,
We recognize that this particular jurisdictional element could be said to be of little practical import. Given the complex state of modern health care delivery, it is difficult to envision any public or private health care plan or contract that does not affect commerce. Thаt is, this jurisdictional element in actuality likely eliminates little from the scope of the statute’s operation. If anything, however, that fact simply serves to strengthen our conclusion that Congress properly exercised its constitutional authority in criminalizing this activity under § 669.
See Gregg,
3. The Presence of Congressional Findings
Although the Court has not departed from the general rule that Congress need not make explicit findings detailing the relationship some particular activity has with interstate commerce, it has directed that such findings may, on the margins, bolster an argument that such a relationship exists where it is not evident “to the naked eye.”
Lopez,
Section 669 was enacted as part of the HIPAA, a massive statute marking significant legislative reform of the health insurance industry. The most relevant and helpful piece of the legislative history with regard to the anti-fraud and abuse provisions of the HIPAA is a report prepared on that subject by the House Committee on Government Reform and Oversight (“Reform Report”). H.R.Rep. No. 104-747 (1996). The Reform Report summarizes the progression of earlier attempts at legislation to address fraud and abuse in the health care industry, and details the extensive need for reform.
The Report states that according to 1995 figures, health care spending in the United States was approximately $1 trillion, divided among Medicare, Medicaid, and various State and private programs. Id. at 2. Strikingly, estimates indicated that as much as 10% of every health care dollar spent — or $100 billion ($274 million a day) — was lost to fraud and abuse. Id. at 2, 7.
These startling figures prompted numerous efforts at legislation, frequently including efforts to craft more efficient and effective federal criminal sanctions. Id. at 2-3. Not surprisingly, Congress was particularly concerned with large scale schemes to defraud Medicare, Medicaid, and massive private insurers operating on a national level, such as Aetna and Blue Cross. Nonetheless, Congress was presented with the unfortunate fact that the problems existed in “all segments of the health care industry” and “in every geographic area of the country.” Id. at 3 (quoting United States General Accounting Office, Health Insurance: Vulnеrable Payers Lose Billions to Fraud and Abuse 2 (1992)). That ubiquity suggests a rational basis for concluding, as Congress did, that even seemingly minor local thefts in connection with health care have direct and significant effects on interstate commerce.
First, the health care industry’s troubling afflictions simply are not confined by “the jurisdictional boundaries that divide Federal, State and local health care finance and law enforcement.” Id. at 1. The relationships among patients, providers, and insurers are extraordinarily complex, and Congress could certainly have reasonably determined that those sophisticated relationships made traditional distinctions between federal, state, and local govern *270 ments at best unhelpful. Second, at its most general level, Congress’s motivation fоr the legislation was the simple fact that billions of dollars were being illegally removed from the health care system at the expense of ordinary citizens, who, as both taxpayers and consumers of health care services, bear directly the dramatic costs of those losses. With regard to the disturbing “scope and variety of health care fraud,” the Reform Report quoted a Department of Justice report stating, “Everyone pays the price for health care fraud: beneficiaries for Government health care insurance such as Medicare and Medicaid pay more for medical services and equipment; consumers of private health insurance pay higher premiums; and taxpayers pay more to cover health care expеnditures.” Id. at 4 (quoting United States Department of Justice, Department of Justice Health Care Fraud Report, Fiscal Year 1994 3 (1995)).
In sum, this history provides independent support for the conclusion that fraud and abuse within the health care industry is a massive national problem that transcends the traditional boundaries of policing as between local, state, and federal governments. It is also readily apparent that such activity — the illegal conversion of many billions of dollars annually — has a substantial effect on interstate commerce. And given the scope and variety of the defects in the system, we cannot conclude that Congress was without a rational basis for determining that it was within its constitutional authority in criminalizing even seemingly minor local thefts or embezzle-ments in connection with health care. Thus, although the absence of detailed congressional findings would not alter our ultimate decision in this сase, we find that the legislative history supports our conclusion that § 669 is a valid exercise of Congress’s Commerce Clause authority. 2
4. The Nexus Between the Regulated Activity and Interstate Commerce
At the core of the Supreme Court’s analysis in Lopez and Morrison was a justifiable if somewhat visceral skepticism about whether the activity being regulated could be sufficiently linked to interstate commerce. In short, the relationship was simply too attenuated — a test for but-for causation may have been satisfied, but it was a search for proximate causation that was ultimately needed. Indeed, both opinions quoted Justice Cardozo’s graphic allusion to this dilemma of causation in his concurring opinion in Schechter Poultry.
There is a view of causation that would obliterate the distinction between what is national and what is local in the activities of commerce. Motion at the outer rim is communicated perceptibly, though minutely, to ' recording instruments at the center. A society such as ours ‘is an elastic medium which transmits all tremors throughout its territory; the only question is of their size.’
A.L.A. Schechter Poultry Corp. v. United States,
The Supreme Court’s opinions in
Lopez
and
Morrison
make clear that the Court has ultimately been most concerned with the potential slipperiness
of
but-for rea
*271
soning. “In a sense any conduct in this interdependent world of ours has an ultimate commercial origin or consequence,” Justice Kennedy noted, “but we have not yet said the commerce power may reach so far.”
Lopez,
The question “is necessarily one of degree.”
Lopez,
In
Wickard,
thе Court “emphasized that although Filburn’s own contribution to the demand for wheat may have been trivial by itself, that was not ‘enough to remove him from the scope of federal regulation where, as here, his contribution, taken together with that of many others similarly situated, is far from trivial,’ ”
Lopez,
Unlike the attenuated but-for relationships present in
Lopez
and
Morrison,
the relation between theft in connection with health care and interstate сommerce is direct and present. At the very least, we will not “second-guess” Congress’s reasonable determination on that score.
5
Bishop,
IV.
Although poorly drafted, Whited’s indictment charged her with embezzling from the Center, a qualifying health care benefit program under the plain statutory language, and thus sufficiently alleged the material elements of the offense. We further conclude that the application of 669 to Whited’s theft was not a violation of the Commerce Clause. Section 669’s regulation of theft or embezzlement from local medical service providers such as the Center is regulation of inherently economic activity. The statute contains a jurisdictional element limiting its applicability to particular instances affecting interstate commerce, and it is suppоrted by a legislative history indicating its part in a comprehensive legislative response to profound problems in the health care industry that are not confined by traditional jurisdictional or geographic borders. Finally, within the broader context of medical service plans and contracts, Congress was certainly justified in concluding that the theft or embezzlement from even a local chiropractor such as the Center has a direct, present, and substantial relation to interstate commerce.
For all of the reasons recited above, the order of the District Court will be AFFIRMED.
Notes
. Although the indictment charged Whited with embezzling $5,956.52, there was evidence indicating that the amount actually involved was far greater. Whited and the government eventually agreed on $34,327 as a reasonable figure for restitution purposes.
. It is worth noting that the Reform Report explicitly, if briefly, considered the question of whether criminalizing these activities was within Congress's Commerce Clause authority, and concluded that "Lopez and the subsequent lower court cases indicate [that Congress] may prescribe health care fraud under its commerce clause powers" because of health care fraud's "interstate attributes.” Reform Report, at 14 n. 46.
. Notably, Congress was apparently concerned with thefts as small as $100, providing specifically in § 669 that such crimes could be punishable with up to a year in prison.
. Moreover, because Congress had a rational basis for concluding that commerce, "we do not have the power to excise, as trivial, individual instances falling within that rationally defined class of activities.”
Bishop,
. The reliance by Whited’s counsel on
United States v. Five Gambling Devices,