Health Care Fraud Investigation and Prosecution

i-resourcesWhat you should expect.

The health care practitioner or provider who is under investigation for health care fraud should have a general idea of what to expect. In the federal system, violations of federal health care fraud statutes are investigated by agents from OIG, the FBI and various health care fraud strike forces. Prosecutions of health care fraud are undertaken by the U.S. Attorney’s Office in the district where the alleged fraudulent activity or billings take place which, generally, is where the provider is located.

Law enforcement agencies have many tools to investigate allegations of health care fraud, including grand jury subpoena power and the issuance of search warrants. Any health care practitioner or provider who receives a grand jury subpoena or has his/her business searched must contact an attorney immediately. Mark Greenberg has over thirty years of experience in representing individuals charged with federal criminal offenses and can help you if you are subpoenaed or if your business is searched.

Sometimes, the federal agent will seek to interview the health care provider who is the “target” of an investigation in order to get information about claims the provider submitted to Medicare or other federal health care program. As long as the target is not under arrest, the federal agent does not have to read the target his or her rights and doesn’t even have to tell the provider that he/she is, in fact, a target of an investigation.

A health care provider who is approached by a federal agent must contact an attorney before agreeing to be interviewed since any statement given to the agent can be used against the provider in court. Even if the provider provides the agent with information that is not incriminatory, the assistant U.S. Attorney (AUSA) handling the case can charge the provider with the felony of making a false statement related to a health care matter if the AUSA believes that the statement is materially untrue. Although it may ultimately be to the provider’s best interest to cooperate with the government agents, that decision should only be made after consultation with counsel. Mark Greenberg can provide the guidance necessary to help the provider make the best decision as to whether to cooperate or not with the agent or prosecutor.

If, after reviewing the results of the investigation, the AUSA decides to charge the provider with a health care fraud offense, the provider may be issued a “target letter” to appear in front of a grand jury. As a practical matter, the target of a health care fraud investigation will never testify in front of a grand jury so as avoid self-incrimination or allegations of perjury. If the provider’s first contact with the investigation is the target letter, the provider must get an attorney since criminal charges are inevitable.

In the federal system, formal charges are instituted either by the filing of an Information or Indictment. An Information is a charge filed by a prosecutor in anticipation of a guilty plea by the accused. An Information is usually filed when the target of the investigation has cooperated with the government in the investigation of his or her own case, or in the investigation of someone else’s case. Sometimes it is in the health care practitioner’s best interest to cooperate with the government from the very beginning of an investigation but that decision should only be make after consultation with counsel.

Most criminal prosecutions begin with the filing of an Indictment returned by a grand jury. A health care provider who has been indicted will be arrested and brought to a federal magistrate judge for arraignment and a bail determination within a reasonable period of time after arrest, usually the same day. Depending upon the nature of the charges and the monetary amount of fraud alleged in the indictment, the prosecutor may ask the magistrate to detain the arrested health provider without bail until the case is disposed of. A detention hearing will be held generally within three days of the arrest at which time by the prosecutor and provider will present evidence that pertains primarily to the provider’s risk of flight. After the hearing, the magistrate can release the provider from custody with certain restrictions, place the provider under house arrest or keep the provider in jail. Any decision of the magistrate judge can be appealed to the district court judge who presides over the case.

The health care provider who gets indicted will either go to trial or plead guilty in the district court. In order to make an informed decision as to what to do, the provider and his or her attorney will review all of the relevant discovery material in the government’s possession, including billing records, statements of witnesses and investigation reports. The provider may need to conduct his or her own independent investigation of witnesses of documents. Only after full and complete investigation will the provider be able to make an informed decision whether to plead guilty or go to trial. Mark Greenberg can help you make the best decision possible under the circumstances.

If you decide to go to trial, Mark Greenberg will fight zealously to get you a NOT GUILTY verdict. Mr. Greenberg has tried literally hundreds of cases in the federal and state courts of Pennsylvania, New Jersey and Delaware and has obtained countless acquittals. Mr. Greenberg has appeared before many of the judges who preside over federal criminal prosecutions and has worked against many of the prosecutors who bring them. With over 30 years of experience trying cases, Mark Greenberg will get you the best result in court. Call him at 267-253-7933.

After reviewing the evidence the government has against you, going to trial might not be your best option. If you decide to plead guilty, Mark Greenberg will get you the best sentence under the circumstances.
The principal criminal health care fraud statutes are entitled:

Health Care Fraud; 18 U.S.C. § 1347
False statements related to health care matters, 18 U.S.C. § 1035
Obstructing criminal investigations into health care offenses, 18 U.S.C. § 1518
Wire Fraud, Mail Fraud and Money Laundering
Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b).