Criminal Investigation into Healthcare Fraud Allegations

If state or federal law enforcement officers have contacted you, there are things you need to know right away. It is possible to avoid criminal charges.

Healthcare Fraud Precharge Representation

Suppose you’ve discovered that there is a healthcare fraud investigation, and you are either a target or a witness. What do you do? Most people in this situation have no criminal history or prior experience with law enforcement. Common, well-intentioned, and intuitive mistakes can have dire consequences. The information contained in this blog will provide you with the essential information you need to know to avoid saying or doing something that causes you harm down the road. If precharge legal representation is in your best interest, it is best to seek experienced legal counsel for healthcare fraud precharge representation immediately.

Investigations are typically done by the Department of Justice (DOJ) Healthcare Fraud Unit, the Michigan State Police, the Federal Bureau of Investigation, the Drug Enforcement Administration, or the Department of Health and Human Services Office of the Inspector General (HHS-OIG). It is not uncommon to see local police departments leading the investigation into more minor offenses or crimes involving one or a few suspects.

The Start of a Healthcare Fraud Investigation

Most people first learn of a state or federal medical fraud investigation in one of the following ways:

Frozen bank account(s) or seized assets
Execution of search warrant (home or office)
Investigating officers or agents show up or call wanting to “talk”
Patients, customers, or clients report being contacted by law enforcement
Signs of surveillance (undercover vehicles, pole cameras, etc.)
Billing audits by the Centers for Medicare & Medicaid Services (CMS) or OIG
Whistleblower tips or a Qui Tam complaint
Medicare or Medicaid complaints or investigations

If an investigation is underway, it is vital to determine if individuals connected to the business, practice, or alleged fraudulent activity are targets, suspects, persons of interest, or witnesses. Unfortunately, the lines between these categories can be blurry and switch quickly depending on the information obtained in the investigation.

Do you tell your side of the story?

The most significant mistake people under investigation make is talking with law enforcement officers or agents. It makes sense to want to tell your side of the story, right? Many people under investigation feel they’ve done nothing wrong and believe that by telling their side of the story, they can avoid a problem or things will go better for them. Although these opinions are intuitive, they are also misconceptions. The most effective way to prevent a problem is to remain silent and not talk to the police or investigating agents.

Police investigators and federal agents are experts at manipulating people into talking. If they can obtain a confession or induce someone to provide information, they drastically increase the odds of a conviction. They will use strategies such as:

“We want to hear your side of the story.”
“If you don’t talk to us, we have no reason to believe you are not guilty.”
“If you are innocent, why would you have something to hide?”
“The honorable thing to do is to take responsibility.”
“If you do not come clean, we will charge your employees (or family, friends, etc.).”
“We are on your side; we just want to get this cleared up and close the investigation.”
“Talk to us ‘off the record,” and it will be just between us.”
“If you talk with us, we can protect you.”
“Be a witness, and you won’t be charged.”
“We just want to talk about some minor inconsistencies.”

What do all the above statements have in common? They are all lies. Do not talk with the police! They are not on a mission to find the truth or help you. Their sole focus is building a case. Remember, the Miranda Warning says, “anything you say can and will be used against you.” Whatever you do, invoke your right to remain silent! One of the quickest ways to turn a precharge situation into criminal charges is to speak to the police or federal investigators voluntarily.

Witness v. Target v. Person of Interest v. Suspect

Sometimes, a person is unequivocally told that they are the target of an investigation or suspected of healthcare fraud. Usually, investigators claim that persons of interest are “witnesses.” They lie because they do not want to scare people and make them reluctant to talk. Remember, their goal is to get people talking. Most defendants are charged with conspiracy or organized crime (RICO). These charges cast a broad net, and many healthcare workers can be caught up in a federal or state charge, even though they had a minor role or were unaware of criminal activity. The line between a witness and a person facing charges is blurry and can quickly shift. It is critical that you contact an experienced defense lawyer right away if you find out you might be implicated in a crime.

“Should I hire a healthcare fraud lawyer for precharge representation, and if yes, when?”

People in the crosshairs of a law enforcement investigation typically have no experience with the criminal justice system. It is not uncommon to question whether to hire a lawyer. Determining when to retain an attorney for precharge representation might also be challenging. The other common misconception is that it might “look bad” if someone hires a criminal defense lawyer.

People do not get charged with federal or state felony healthcare fraud charges because of how they look. People get arrested because of evidence (truthful, untruthful, exaggerated, or misunderstood). In most criminal cases, unrepresented suspects and witnesses get tricked and manipulated into incriminating themselves. Law enforcement officers are so well trained that they can trick an innocent person into saying something or doing something that can be misinterpreted. It is vital that you hire an experienced attorney immediately. The sooner you get someone on your side protecting and defending you on a precharge representation basis, the greater the chances of avoiding or limiting charges and maintaining your freedom.

Role of a Healthcare Fraud Precharge Investigation and Consultation Attorney

A great lawyer has a broad role in the precharge stage of a healthcare fraud case. In addition to protecting their client from law enforcement investigators, they collect favorable evidence, interview witnesses and secure favorable statements, hire investigators, and facilitate mitigation such as therapy, LARA intervention, billing reforms, and more. If you call LEWIS & DICKSTEIN, P.L.L.C. for a free consultation regarding precharge representation, we will take the time to talk with you and develop a strategy to protect and defend you.

Healthcare Fraud Charges in State and Federal Court

The government utilizes many different charges to prosecute these offenses. Frequent charges include wire fraud, bank fraud, mail fraud, tax fraud, distribution of controlled substances, prescription fraud, and more. For a conviction, the government must prove, beyond a reasonable doubt, that the defendant:

devised a scheme or artifice;
to defraud a healthcare benefit program; and
that the scheme was executed.

Penalties for Healthcare Fraud

A person convicted of a charge related to healthcare fraud can expect significant direct and collateral consequences, such as:

Felony conviction
Jail or prison (some offenses carry 10- and 20-year prison sentences)
Years of probation or pretrial release
Fines
Forfeiture
Restitution
Loss of a professional license
Deportation or Inadmissibility for Non-U.S. Citizens
Bar to naturalization for green card holders and permanent residents
Loss of board certification or other credentials
Loss of civil rights, like the right to vote and possess firearms
Termination of Employment

The best way to avoid the harsh penalties associated with a criminal conviction is to engage the services of a seasoned criminal defense attorney for precharge representation as early as possible. A savvy lawyer can often persuade the government to settle a case without charges or agree to file less severe charges.

Common allegations in these matters include:

Accepting kickbacks for patient referrals
Exceeding opioid prescribing guidelines
False or inflated claims
Exceeding urinalysis testing guidelines
Billing for services not provided
Exceeding guidelines for back injection
Performing unnecessary or overly complex medical services
Improper entries into medical records
Upcoding
Unbundling
Billing improper CPT Codes (sometimes called “Upbilling”) (99211-5)

How do I get assets, like bank accounts, unfrozen?

Law enforcement officers know that the best way to get people to incriminate themselves and prevent them from hiring a lawyer who can protect them is by cutting off their access to money. They freeze bank and investment accounts, seize valuable assets like cars and boats, and seize cash from searched locations. They are trying to prevent suspects in healthcare fraud investigations from hiring lawyers for precharge representation. If you can hire an experienced criminal defense lawyer right away, they can often get assets unfrozen or released and limit potential federal or state criminal charges.

What types of people are at risk of charges or an indictment for healthcare fraud?

Because the government typically uses charges like conspiracy and RICO, everyone has a reason to be concerned. For example, consider a doctor’s office. Everyone at a medical office, from the receptionist, nurses, physician assistants, medical technicians, doctors, billing employees, and bookkeepers, all risk accusations of involvement. Investigators almost always threaten employees with charges if they don’t cooperate or provide information about their employers or co-workers. Again, these tactics are manipulations and falsehoods. Although a respected, influential attorney might be able to negotiate to avoid charges, a person is helpless to meaningfully protect themselves. Common targets of healthcare fraud investigations include:

Doctors,
Pain Management Specialists,
Chiropractors,
Pharmacists,
MRI operators and owners,
Medical billing company employees,
Cooperating or referring doctors and nurses,
Physical therapists, and
Medical practice owners (white-collar crime).

Healthcare Fraud Defense Following Precharge Representation

If charges cannot be avoided, the accused person is charged in state or federal court. Federal criminal charges, in particular, can result in up to 10 or 20 years in prison. A state charge commences when the prosecutor files a complaint. Federal charges start with a complaint or indictment. A top defense lawyer will defend these charges early and aggressively, especially when the lawyer is already onboard as pre-charge counsel. Most defenses in these cases require expert testimony from certified healthcare providers, billers, or other medical professionals. Depending on the defendant’s role, the defense must be customized to give them the greatest chance of obtaining a dismissal, reduced charges, or a lenient sentence. With a robust and credible defense, it is often possible to avoid a conviction, asset forfeiture, and incarceration.

Healthcare Fraud Precharge Representation

Our healthcare fraud defense attorneys have achieved numerous dismissals and acquittals for clients. When hired for precharge representation, we’ve been able to help clients avoid charges, unfreeze assets, and negotiate for less severe criminal charges. By utilizing a unique team approach, we routinely achieve results unobtainable to many lawyers who purport to be experts or specialists. Our team has decades of experience successfully defending clients on healthcare fraud-related charges in federal court and courts in Oakland County, Wayne County, Washtenaw County, Macomb County, and throughout Michigan. When there is no room for errors and false promises, and you need the best possible defense, LEWIS & DICKSTEIN, P.L.L.C. is your best hope. We are not afraid to win!

Call us for a free consultation. We will take the time to talk with you, answer your questions, and address your concerns.

Call us today at (248) 263-6800 for a free consultation or complete an online Request for Assistance Form. We will contact you promptly and find a way to help you.