DC Federal Healthcare Fraud Charges and Investigations

Facing DC federal healthcare fraud charges and investigations can feel daunting without the help of a dedicated healthcare fraud attorney. Speaking with a lawyer could be beneficial to the outcome of your case.

Types of Healthcare Fraud Investigations

DC federal healthcare fraud charges and investigations involve document reviews by law enforcement agencies that include billing records, emails, medical bills, medical charts, and things of that nature. The documents are usually obtained through subpoenas.

Defining Investigative Tactics

Search warrants are sometimes used further along in an investigation because when a search warrant is used, the person whose office or home is searched knows about the investigation at that point. They would not necessarily know about a subpoena for banking records, or emails, or other documents.

An undercover operation is sometimes employed in the healthcare investigation where a law enforcement agent poses as a patient and wears a wire or has a video camera when meeting with a healthcare professional. The agent attempts to obtain incriminating evidence from the target of the investigation.

What Federal Agencies are Involved in Healthcare Investigations?

State agencies can be involved in healthcare fraud cases. More typically, federal agencies are involved including the FBI. Sometimes, law enforcement or the Office of the Inspector General of a particular federal agency such as Health and Human Services or the Department of Labor is involved in a federal healthcare fraud investigation.

Because healthcare fraud cases are often charged as conspiracies, the government must prove that two or more people agreed to do an illegal act and at least one overt act was taken in the furtherance of the agreement to do something illegal. The act itself does not have to be illegal.

As an example, two people agree to defraud Medicare or Medicaid by fabricating a billing input for treatments that never occurred. The agreement is made and one of the two people buys a computer. While buying the computer is not illegal, the purchase could be considered an overt act in the conspiracy to defraud a healthcare program.

How the Prosecution Proves Intent

The prosecution proves specific intent to defraud a healthcare program. The evidence is usually circumstantial and the intent is inferred circumstantially. There is generally nothing in writing that proves two or more people agreed to defraud a healthcare program.

The government uses the surrounding circumstances to prove that a person accused of fraud intended to engage in fraud. Information from the DC federal healthcare fraud charges and investigations will then be shared. This information can include emails, medical records, and banking records. This evidence might show a pattern that can be used to prove intent.

Direct evidence could be obtained that demonstrates specific intent when a law enforcement agency obtains permission to tap a person’s home, business lcell phoneellphone or through the use of an undercover law enforcement agent.

Expectations

A healthcare investigation begins with a tip from someone or a piece of information given to a law enforcement agency that leads to a request for documents or a subpoena. Financial records, medical records, emails, and other documents are obtained through subpoenas.

A grand jury investigation could be opened through which subpoenas are generated or authorized. Records such as banking records, medical records, emails, and phone records are analyzed. People may be interviewed or called before a grand jury.

At some point towards the end of DC federal healthcare fraud charges and investigations, there is an attempt to interview the person who might be charged and a search warrant may be executed for their home and/or business. A charge is usually filed shortly afterwards.