The federal government uses a variety of tools to conduct investigations in healthcare fraud cases, which DC federal healthcare fraud attorneys can use. A tremendous amount of electronic or paper data can be generated. Federal investigators subpoena those records and look for patterns that lead to the discovery of an alleged illegal activity.
Undercover agents might pose as a patient, go to a doctor’s office, and investigate. When there is a suspicion of illegal activity, the undercover agent may try to get a doctor or staff member at the doctor’s office to commit an illegal act. Wiretaps are also used in DC federal healthcare fraud investigations. The government has strong subpoena power to subpoena patient and healthcare records as well as emails to try to uncover and corroborate allegations of illegal activity.
Subpoenas
There are few areas where trying to subpoena documents becomes problematic. Subpoenas that interfere with attorney-client privilege can create issues. In addition, there are protections that patients have under HIPAA that may create problems when healthcare records are subpoenaed. Those issues must be navigated by lawyers representing the doctor, hospital, or other facilities where documents are being summoned.
Federal and State Agencies Involved
There can be state agencies involved in a DC federal healthcare fraud investigation, however, many times the state agencies combine with federal agencies to form a task force and combine their efforts to investigate allegations of illegal activity. The primary federal agencies that can be involved in healthcare related investigations are:
- The Federal Bureau of Investigation
- The Office of Inspector General of the U.S. Department of Health and Human Services
- The Department of Labor
- The Internal Revenue Service
Expectations of Healthcare Fraud
When someone faces healthcare fraud charges for the first time, they should expect an extensive and invasive investigation. It can also be expensive because records are subpoenaed many times when a healthcare provider is under investigation. The person must hire a lawyer to deal with all the ramifications of the subpoena. There are also stiff penalties imposed, including incarceration, when someone is convicted of a healthcare fraud violation.
As the investigation proceeds, there are a couple of different things that can happen. A defense lawyer could conduct their own an investigation and speak at length to the individual. The lawyer can attempt to find holes in the investigation so that the government would decline to further prosecute, which may or may not happen.
When charges are officially lodged, the person goes to court to start the charging process and then the case continues through the court system.
Social Ramifications
With a federal investigation, the level of publicity depends on the U.S. attorney’s office in charge of the investigation. Some U.S. attorney’s offices publicize these allegations extensively. Arrests in the newspaper might be on the Internet forever.
Other ramifications include a person having their medical license suspended or a person being fired. A doctor charged with a healthcare fraud violation in a DC healthcare fraud investigation can have their license suspended by the medical board until the charges are resolved. A person working at a healthcare company could be suspended or fired as a result of being charged as well.
