Targeted In A Federal Health Care Fraud Investigation? A Dallas White Collar Defense Attorney Can Help

Spencer & Associates | Proven Health Care Fraud Representation in Dallas, TX

Because health care fraud results in hundreds of billions of dollars in losses to the healthcare industry and government benefit programs each year, the federal government pursues these crimes vigorously. If you’re the subject of a federal health care fraud investigation, you should know that you potentially face years of imprisonment and fines running into the tens of thousands if you’re convicted. You’ll also have to confront damage to your reputation and career.

Charges of overbilling, phantom billing, providing unnecessary treatments or prescribing unnecessary drugs are serious allegations necessitating a serious and skilled defense. Spencer & Associates has worked tirelessly and successfully for health care fraud clients for decades. With their skilled representation, you stand your best chance of avoiding a conviction or minimizing its impact on your professional standing.

What To Do If You Are Contacted By Federal Investigators For Health Care Fraud

An investigation into your role in health care fraud is a serious matter with potentially grave consequences. That’s why it’s imperative to know your rights and how to proceed in a legally compliant manner.

In this article, you’ll learn what to expect and what to do next if you are investigated for health care fraud.

What Federal Agencies Investigate And Prosecute Health Care Fraud in Texas?

Several federal agencies and departments work together and separately in complex ways to investigate and prosecute health care fraud in Texas. Any one of the following may reach out to you if they have reason to believe you perpetrated, or know details about, health care fraud:

• The Criminal Division of the US Department of Justice (DOJ) – Health Care Fraud Unit – The DOJ coordinates nationwide health care fraud investigations and prosecutions, working closely with US Attorneys’ Offices.
• The Federal Bureau of Investigation (FBI) – Dallas Field Office – Conducts criminal investigations into health care fraud.
• US Department of Health and Human Services Office of Inspector General (HHS-OIG) – Operates the Medicare Fraud Strike Force and partners with the FBI and DOJ to investigate fraud in federal health programs, such as Medicare and Medicaid.
• US Attorney’s Office for the Northern District of Texas – Prosecutes federal health care fraud cases that originate in Northern Texas.
• Centers for Medicare & Medicaid Services (CMS) Center for Program Integrity – Performs fraud analytics (suspicious claims and billing data) and refers cases to law enforcement agencies for investigation.
• Texas Attorney General – Medicaid Fraud Control Unit (MFCU) – Works with federal agencies to investigate Medicaid fraud cases throughout Texas.

What Should You Do First If Federal Investigators Contact You About Health Care Fraud?

If federal investigators contact you, your first step should be to say nothing and decline any interviews until you speak with an attorney. If you retain counsel, someone who is knowledgeable about health care fraud and experienced in defending it, they can:

• Determine whether you are a witness to the fraud or the target of the investigation
• Communicate on your behalf with investigators
• Advise you about procedure, rights and obligations regarding subpoenas, interviews and search warrants
• Help you organize and preserve your records properly

It’s also imperative that you don’t obstruct the investigation, destroy or alter records, or make any false or misleading statements to investigators.

What Happens If You Receive A Federal Subpoena Related To Health Care Fraud?

Receiving a subpoena from a federal agency or department means they have reason to believe you or your organization has relevant information regarding a criminal or civil health care fraud investigation. Depending on the type of subpoena, you may be asked to provide testimony at a hearing or produce records.

The subpoena will require you to preserve all records. Those records include billing records, patient files, emails and texts, financial records, contracts and more. Any attempt on your part to destroy or alter records can result in allegations or charges of obstruction.

The federal agency or department that issued the subpoena may already possess considerable evidence, such as billing data analysis or whistleblower allegations, bank records or claim histories. For that reason, your best course of action is to have a medical fraud lawyer review the subpoena to determine:

• Whether the matter is civil or criminal
• The timeline for response
• The scope of the records requested and whether that can be negotiated
• Whether there’s room for negotiation regarding sanctions or outcomes

What Mistakes Should You Avoid When Speaking With Federal Agents About Health Care Fraud?

Federal investigators are highly skilled at interviewing and are likely to possess considerable evidence already. That’s why it’s best to avoid answers that are speculative, elaborative, inconsistent or dishonest. Also, avoid consenting to any broad searches of your records before you understand the investigator’s request.

The wisest strategy is not to speak with investigators without first consulting experienced counsel.

Still Have Questions? Call Us!

Spencer & Associates is a recognized, leading white-collar defense firm serving the Dallas-Fort Worth Metroplex. If you’ve been implicated in a federal health care fraud investigation and are wondering what to do next, contact us today at (214) 376-4441 for a free consultation or schedule an appointment on our website.