Federal Healthcare Fraud Investigations

Below, a federal healthcare fraud lawyer discusses how federal investigations of healthcare fraud take place and what agencies are typically involved. Call today to discuss your case or learn more about this type of fraud.

There has been a recent uptick in the amount of federal health care fraud cases, and the government has become much more savvy in tracking down the fraud as the use of computers has become much more pervasive. The government is able to track information much more effectively and is able to more quickly and accurately find areas of potential fraud and potential abuse and then quickly move in.

In general, as more and more of our population in this country ages, as the baby boomers are getting older, the amounts of money involved in healthcare just keeps rising, and so it becomes an area that is just ripe for fraudulent activities. As a result, there has definitely been an increase in fraud that coincides with the amount of money and the size of these programs.

Federal Investigations

The Department of Health and Human Services and the Department of Justice (DOJ) have a joint task force that specifically looks into healthcare fraud cases. In addition to these federal investigations that occur, state and local authorities also pitch in to investigate fraud because of the prevalence of local and state health care programs.

In many investigations, there will be some form of an audit done looking at the billing practices of a provider, like a doctor’s office or an ambulatory service, looking at what specifically is being submitted and charged and whether or not that seems to make sense—whether or not that’s valid.

Fraud investigations almost always start with an examination of detailed record keeping, and then, if the federal or state investigators find what appears to be red flags for fraud, they can then focus in on questioning the right individuals, for example, going and talking to patients to see if they actually received certain medications and services.

In addition, you can expect the government to begin looking through any kind of electronic transmissions related to the fraudulent activity and to subpoena everything that they can, including any records possessed by the individual in question, to see if what he or she is doing is fraudulent or not.

Agencies that Investigate Health Care Fraud

Many health care fraud investigations involve the United States Attorney’s Office, Department of Justice, Health and Human Services, and sometimes you’ll even see the IRS involved. The FBI is often called in as the federal law enforcement agency on the scene in many of these cases. Those are entities that you can almost count on seeing.

Since Medicare money flows through the states, oftentimes individual states will have their own investigation arm that can allow state and local law enforcement get involved as well. These state and local organizations assist as the government attempts to get information and track down the information to prove their fraud case.

So, in a major federal healthcare fraud case, you can expect to see numerous investigation entities at the federal, state, and local levels.

The Role of a Lawyer

When a client is facing federal health care fraud charges, it is the job of a federal health care fraud lawyer to ensure that his or her client is receiving the benefit of due process and that all evidence admitted in court was gathered legally and without violating any of the client’s rights. This may not sound like such a big deal, but when investigators cut corners, key pieces of evidence can be completely thrown out, which can improve a defense attorney’s ability to negotiate favorable plea bargains or even have serious charges dropped or dismissed.

To learn more about federal health care fraud investigations and to see how you might benefit from the services of a federal health care fraud attorney, call our law offices today and request your free initial consultation.