Evidence in Federal Healthcare Fraud Cases

Facing federal health care fraud charges can be intimidating, but it helps to know what you’re up against. In any DC federal health care fraud case, federal prosecutors will attempt to prove certain elements in order to obtain a conviction. To do so, they normally rely on specific types of evidence. This page discusses what the government must prove in a healthcare fraud case, as well as the types of evidence that are used in the process.

A federal healthcare fraud lawyer in DC can explain more fully how these facts may influence your particular case. Call our DC law firm today to take advantage of your free initial consultation and learn how a federal defense attorney can help to protect you.

What Does The Government Need To Prove In DC Federal Healthcare Fraud Cases?

In a DC federal health care fraud case, the government is going to have to prove that an individual knowingly and willfully used (or attempted to use) some kind of scheme to defraud a government-sponsored healthcare benefits program. This can include knowingly and willfully attempting to take part in a scheme to obtain any kind of money or benefits from the healthcare benefit program by means of using fraudulent representations or pretenses.

In simple terms, the government is going to have to show that the individual knew that what he was doing was fraudulent and engaged in some form of scheme to effectuate that fraud. Pertaining specifically to healthcare fraud, the government will have to prove that the object of the fraud was to get a benefit from a healthcare benefit program.

What Evidence Will The Government Typically Use To Prove These Elements?

The government is going to focus on what claims and other documents were submitted to the healthcare benefits program and compare that to what actually occurred at the source in order to demonstrate what was submitted involved an attempt to defend the healthcare program. They’re going to show from both ends what was received and what was sought and was actually gained and used.

How Does The Prosecution Prove Intent?

In a DC federal health care fraud case, intent can be proven by circumstantial evidence. Very often, the government is not able to provide that smoking gun in the form of an e-mail or a letter or a witness willing to testify as to what the perpetrator of the fraud actually intended while engaged in a fraudulent scheme. Typically, individuals who are allegedly committing a fraud are a little more sophisticated than that.

Circumstantial Evidence

To prove intent, the government does not actually have to establish with direct evidence that the person was attempting to defraud a healthcare benefits program. Rather, they can use circumstantial evidence. In other words, they can go in and show that certain individuals submitted claims to certain benefits programs for certain services that were never rendered to those clients.

Generally, these incidents cannot be considered mistakes, and they must be something that went on for a length of time, something that cannot be simply explained by a bookkeeping error or a typographic error. In other words, federal prosecutors can show that the fraud in question was a pervasive scheme and that it simply doesn’t make sense that the person was submitting fraudulent claims innocently.

Effects of Federal Health Care Fraud Investigations

During the course of investigation, it substantially disrupts the business of the individual who is the target of that investigation as clients are being interviewed and as records are being obtained, since the government can come in and actually take the physical records from the office. Federal investigations disrupt business and can potentially halt all future claims to a specific program if the government believes that the fraud is actually occurring. And so, it’s going to create a major problem for the individual who’s the target of the fraud investigation.

Working with a Federal Defense Attorney

There are a number of services a federal health care fraud lawyer can offer in order to help protect clients during the course of a federal investigation. However, due to the complexity of these cases, it is necessary for your attorney to have a full understanding of your case in order to help you proceed.  Call our law offices today to conduct your free consultation and learn about your options.