Facing DC Federal Healthcare Fraud Charges

What Should Someone Expect If They’re Facing Healthcare Fraud Charges?

David Benowitz: Well, they should expect that there’s going to be a full court press by the government to try and convict them.  They should also expect that both their home office and place of business will be most likely raided by federal agents armed with a search warrant who will then take documents, computers, phones, and other items from the office and home as part of that search. That’s often the the first indication they are under investigation for healthcare fraud.

Sometimes a bank will notify a person that their account has been frozen or that a subpoena has been issued for their bank records. That’s another thing that people should expect is for subpoenas to be issued. Also, they can expect that the government may attempt to freeze their business accounts while an investigation against them is pending. If someone is running a healthcare facility like for example an MRI center, then  they can expect that the government will try and freeze the operating account for that business.

What Does The Government Need To Prove In a Healthcare Fraud Case?

David Benowitz: It depends on the charge. Normally, the government need to prove willfulness, or knowledge that the activity the person was engaging in was done in order to fraudulently obtain money either from a federal healthcare program or to obtain money for example from Medicare and Medicaid fraudulently.

But the key is they have to demonstrate willfulness. The  government has to show that the person knew what they were doing was wrong, they knew what they were doing is fraudulent, and did it anyway. That’s the key.

What Can Happen During The Course of Healthcare Fraud Investigation?

David Benowitz: When we undertake to represent someone in a healthcare fraud investigation, what we do is we try and get from either the law enforcement agent, the prosecutor, or both a sense of what they think our client is doing illegally.

Then, what we do from there is we investigate and try to show the prosecutor that either what’s going on is not illegal, or maybe it was something that wasn’t being done by our client.

There have been times where we’ll go to the government and say we looked into this and based on the facts what was actually occurring is not illegal and that you’re actually allowed to do this.

There is that component to litigating this type of investigation.  In my experience, there are times that the government is simply incorrect in its belief that a certain activity is illegal. There may be a particular type of billing, a certain way documents are prepared, or the way approvals are obtained from doctors, which may look fishy to the government but are actually legal.

What Happens Once An Individual is Formally Charged?

David Benowitz: When someone is formally charged, we usually try and have a prior arrangement in place with the government where we’ll say to them that if you’re going to formally charge this person, let us know and we’ll bring him down to court.  That  way you don’t have to come out and arrest the person. We would bring them to court make the process as pain free as possible.

There’s a court hearing known as either an initial hearing or a presentment where a person is informed in a basic way what the charges are. If an indictment has come down, then it’s called an arraignment.   Then, the case begins in court. We try and  get an agreement with the government beforehand that will not detain our client beforehand and we had very good success with that. So, again, we try and make the process as smooth and pain free as possible.

After the initial hearing or arraignment,  we will continue investigating the case and continue to push the government to either dismiss the case or to further define what they actually think is wrong. Sometimes, it becomes a moving target that the government thinks one thing is wrong  when they started the investigation but end up indicting on a different theory  based on different information that the government didn’t have at the beginning of the case. We have to respond to that.