When a person is formally charged with healthcare fraud, their lawyer makes arrangements for the person to turn themselves in. The person appears in court and the charges are lodged. There would be a hearing to determine whether the person can stay in the community while the case proceeds. However, the government may attempt to lock the person up in jail during the pendency of the case.
The defense lawyer might be able to convince the government to refrain from doing that. When the government persists, the defense lawyer fights that in court. If a person is released on certain conditions, the judge establishes what those conditions are and the lawyer makes sure they are reasonable.
At that point, the lawyer in a DC federal healthcare fraud case continues their investigation and determines how the case should proceed. There could be a trial or some resolution with the potential client’s consent and direction.
Depending on the case, the types of evidence in a DC federal healthcare fraud case can include:
The person is arrested and gives an interview that incriminates them. When law enforcement interviews the person, there can be portions of the interview in the government’s presentation of evidence.
The authorities sometimes get information from a doctor’s office and have the nurses or medical staff provide testimony about what happened. When an individual is charged with healthcare fraud, the prosecutor may look at an insurance company and its employees who interacted with the person making the claims in addition to investigating the doctor who provided treatment or gave prescriptions.
Other evidence in a DC federal healthcare fraud case is handwriting and expert witnesses, but handwriting experts are usually not used or are used less frequently.
An expert witness in a healthcare-related case could be someone with experience in detecting patterns of misconduct, coding of treatment, or falsification of treatment. Because healthcare billing can be complicated, there is often debate about whether a particular type or use of a treatment or billing code is improper. That can result in a request for expert testimony.
Whenever a person is charged with fraud, there must be an element of intention. In other words, a person must knowingly and willfully commit fraud. They have to know what they are doing, and their actions cannot be accidental.
For evidence in a DC federal healthcare fraud case, the government must prove that the person knew what they were doing. It is rare that someone admits to committing fraud, which is the reason for such extensive investigations into records, emails, text messages, and social media. The government tries to prove fraud through circumstantial evidence that is not a direct admission. They use emails or financial transactions that indicate illegal actions and that the person knew it was illegal.
An example of governmental evidence is medical records. The government tries to establish a pattern they can use to argue that someone deliberately did something illegal. Wiretaps can also be used to gather evidence. A wiretap can record someone’s phone or other communications devices to prove that someone talked about doing something illegal when they were not aware of being recorded. Also, the subpoena of emails and other records can establish evidence of communications and of associations with people that infer that a person did something illegal.
It is important to have an experienced healthcare fraud attorney because of the complex ideas surrounding DC federal healthcare fraud. There is an intersection of medical treatment issues with constitutional and criminal justice issues that can be confusing. A person needs an attorney with experience to interpret the evidence and identify the best way to address a DC federal healthcare fraud case.