In a healthcare fraud case, the government must prove that the defendant made claims for coverage that were not authorized by their insurance coverage. The investigators determine whether there is a medical basis for the treatment that might be covered. They decide whether the insurance policy covers the submitted claims. Depending on the level of investigation, the investigators determine whether the treatment is legitimate. For example, sometimes doctors are accused of saying they provided a treatment they did not provide or provided specific procedures that could be viewed as medically unnecessary.
Read below for more information about prosecuting DC federal healthcare cases. And if you are facing charges, reach out to an experienced healthcare fraud lawyer.
To prove intent when prosecuting DC federal healthcare cases, the prosecution may use circumstantial evidence. In these cases, the prosecutor may want to argue to the jury that the defendant made claims for insurance coverage they knew they did not have, or made claims for treatment or procedures they did not receive. Under those circumstances, the defendant may be at great risk if there is no persuasive explanation as to what actually happened.
The government obtains bank, medical, insurance company claims, and hospital records to be used by the prosecutors as evidence in court. They sometimes provide testimony from doctors, nurses, and hospital administrators to prove that false claims occurred.
Healthcare fraud cases can be enormously complicated as healthcare laws are extensive and detailed. When someone is charged with healthcare fraud, they need an attorney who can help them build the best defense against those charges and find the legal arguments that are protective of their position and rights. An experienced defense attorney helps the defendant navigate the court process including making sentencing guidelines calculations, negotiating with the prosecutor, and presenting evidence at the jury trial. Someone facing healthcare fraud charges needs the guiding hand of a seasoned attorney to help them maximize their opportunity to get the best possible results in extremely difficult circumstances.
The investigation is an essential part of a case. When there is a healthcare fraud investigation, there is a good chance that the individual who is the target of the investigation will be contacted by an investigator to request an interview. An investigator may show up unannounced to try and catch the person off guard. One should never give an interview without having counsel present. Sometimes, the attorney advises the individual to not give that kind of interview.
A person who is suspected of healthcare fraud should make sure they have an attorney to advise them whether they might create more problems for themselves by giving an interview. There may also be issues with the subpoenas for information. The investigators might interview other people who are potentially connected to the situation.
If a doctor is being investigated, the authorities may interview patients, nurses, and medical staff to get additional information. When an individual makes a claim, the authorities contact the insurance company that manages their account. Sometimes, an investigator visits the places the person claims provided their treatment to make sure they received the treatment.
If you have any questions about prosecuting DC federal healthcare cases, reach out to an attorney today.