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Maryland Federal Healthcare Fraud Investigations

Maryland federal healthcare fraud investigations usually center around the financial recordkeeping of a healthcare provider. The investigation involves a review of the financial records to see what payments were made and to see if expenses match what was reported or billed. Criminal investigations often involve interviews with the employees of the healthcare provider and with patients. If you are under investigation for committing healthcare fraud, contact a seasoned defense lawyer today.

Federal Agencies Involved

The Department of Justice and the FBI will usually spearhead an investigation of Maryland federal healthcare fraud. These two organizations are the most common agencies involved in federal investigations. The Health and Human Services is the cabinet-level department of the US government that oversees healthcare in the country. Their team of investigators, in cooperation with the FBI, may also investigate for healthcare fraud. The government takes Maryland federal healthcare fraud investigations seriously, and every FBI field office has agents specifically designated to investigate.

The federal agencies often work with state agencies and the state medical regulators. Tax authorities may be involved because while Medicare is a federal program and a lot of the payments are federally-based, many state agencies implement federal regulations and distribute federal healthcare-related funds.

Government’s Burden of Proof

When investigating a healthcare fraud case, the government needs to prove that the individual committed an unlawful practice in regards of the healthcare laws and regulations and that the individual knew what they were doing when they committed the act or acts in question. The nature of the specific act(s) and the corresponding proof varies in accordance with the specific allegations of fraud.

For example, if the allegation is that a provider billed for services that were not provided, the government needs to prove that those services were billed, the service was not provided, and that this fraudulent billing was done intentionally.

Healthcare Fraud Investigation Process

When the government is alerted of healthcare fraud, they start to investigate if there is any substance to the claim. If no fraud is found, then the investigation closes. If the government finds evidence of what they believe is fraud, they file charges, issue an arrest warrant, obtain an indictment, seek an indictment with the grand jury, and proceed with the case.

Depending on the initial target of their investigation, the evidence, and the information uncovered during the investigation, the government may want to turn the initial target into a cooperative witness. If the original target is determined to be a low-level participant in a larger fraud scheme, the government could use the threat of charges as leverage to get the person to help them take down the individuals higher in the scheme’s hierarchy.

The government could make a reverse proffer. A proffer is when an individual offers information to the government in exchange for a more lenient charge. The purpose of the reverse proffer is to show the individual that it is in the person’s best interest to cooperate. For more information about the Maryland federal healthcare fraud investigation process, call an experienced lawyer.