Types of DC Federal Healthcare Fraud Cases

Federal law has a couple of main categories of offenses that address the various types of DC federal healthcare fraud cases. To learn more about the type of charge you are facing, contact a driven federal healthcare fraud attorney.

Common Types of Healthcare Fraud Cases

Wire fraud and mail fraud are often used under federal law to target healthcare offenses in addition to other offenses and different sub-scenarios.

For example, a wire fraud charge in which an email is sent as part of a conspiracy to defraud a healthcare provider or to defraud Medicaid or Medicare might establish a federal charge that involves healthcare fraud.

There are also specific statutes that deal with healthcare offenses, such as defrauding specific government programs like Medicaid or Medicare.

Who is Normally Charged with Healthcare Fraud?

People are charged with health care fraud under different circumstances. Doctors are charged with defrauding Medicaid or Medicare through different methodologies. One of the accusations involves instances of up-coding where a medical procedure with a specific code from the national code system is billed as another procedure with a more expensive rate. Sometimes doctors are accused of fabricating patients and falsifying procedures in an attempt to be paid more than what they are entitled to receive.

Does Fraud Only Occur in Facilities?

A division of charges addresses offenses involving home healthcare aid providers. Some companies have allegations against them that their home health care providers misrepresent hours to the tune of millions of dollars.

The hours did not involve taking care of patients but were spent filling out time sheets. The home health care aids sometimes charge Medicaid or Medicare for work that is never done.

Evidence Involved in Health Care Fraudulence

Common types of DC federal healthcare fraud cases usually involve written documents. Many records can be involved including medical records and financial records. Prosecutors look for records that can be interpreted as a pattern by witnesses.

The government often attempts to condense evidence in a summary chart based on their analysis of documents. For example, a government agent analyzing billing records may identify a doctor using a specific code for a procedure that is larger than another code for the treatment.

The prosecutor may present a patient as a witness who testifies that although their chart shows they received a more expensive treatment, they never received that treatment.

Impact of Federal Healthcare Fraud Cases

Over the past few years, there has been an uptick in the amount of federal healthcare fraud cases, although it varies by federal district. There is an increase in the prosecution of these types of DC federal healthcare fraud cases in the home health care fraud arena to the patient, on the pharmacy side, and in Medicare and Medicaid programs.

The increase in the illegal activity is because a large amount of money can be gained through the sale of the drugs and because the drugs involved are highly-addictive painkillers such as fentanyl and other opioids. These drugs are easy to overdose on and are extremely dangerous if they fall into the wrong hands.

It is important to have an attorney with experience in these types of cases and evidence because the cases are prosecuted so aggressively. The defense lawyer should know how to do the investigation in these cases. They need to understand what the government is trying to prove and the types of patterns they may attempt to show.