Healthcare fraud investigations can threaten your freedom, professional license, career, business, finances, and reputation. Physicians, healthcare professionals, business owners, executives, and medical providers facing a federal investigation should take the matter seriously from the beginning.
Tampa healthcare fraud defense attorney Michael J. Petro represents individuals and businesses facing federal healthcare fraud investigations and criminal charges in Tampa and throughout Florida.
With over 35 years of criminal defense experience, Attorney Petro represents clients at every stage of a federal criminal matter, including investigations, grand jury proceedings, indictment, trial, sentencing, and federal appeals.
Federal Healthcare Fraud Investigations
Healthcare fraud cases are often investigated long before criminal charges are filed.
Federal investigators may review billing records, patient files, financial transactions, electronic communications, referral relationships, prescription records, and other evidence before prosecutors decide whether to pursue criminal charges.
Federal healthcare fraud investigations may involve agencies including the Federal Bureau of Investigation, the Department of Health and Human Services Office of Inspector General, the Drug Enforcement Administration, and other federal and state agencies.
A healthcare provider may first learn about an investigation when federal agents request an interview, employees receive subpoenas, the business receives a grand jury subpoena, agents execute a search warrant, or Medicare or Medicaid billing activity comes under scrutiny.
If you believe you are the subject or target of a federal investigation, consulting an experienced Tampa healthcare fraud defense attorney before speaking with investigators can help protect your rights and allow counsel to begin evaluating the government’s allegations.
What Is Healthcare Fraud?
Federal healthcare fraud cases can involve allegations that an individual or business knowingly participated in a scheme involving false or fraudulent claims for healthcare benefits, services, or payments.
Investigations can arise from many different types of alleged conduct, including:
- Billing for services that were not provided
- Billing for medically unnecessary services
- Submitting false claims to Medicare or Medicaid
- Misrepresenting services provided to patients
- Using incorrect billing codes
- Upcoding
- Unbundling services
- Duplicate billing
- Improper referral arrangements
- Kickbacks
- False certifications
- Prescription-related fraud
- Durable medical equipment billing
- Home health care fraud
- Laboratory testing fraud
- Telemedicine-related allegations
- Conspiracy to commit healthcare fraud
Not every billing error or disputed claim constitutes criminal fraud. Healthcare billing and reimbursement rules can be complicated, and the government must prove the elements of the criminal offense charged.
Medicare and Medicaid Fraud Investigations
Medicare and Medicaid fraud investigations can involve enormous quantities of billing and patient data.
Federal investigators may use statistical analysis, claims data, witness interviews, financial records, undercover operations, and information from current or former employees to develop a case.
Investigators may examine whether services were actually provided, whether they were medically necessary, whether documentation supports the claims submitted, and whether financial relationships influenced referrals or billing.
Healthcare providers should be particularly cautious about attempting to explain disputed billing practices to investigators without first understanding the scope of the investigation.
Statements made during an investigation may later be used as evidence in a federal prosecution.
Healthcare Fraud and Intent
Intent can be a critical issue in a healthcare fraud prosecution.
Healthcare organizations often involve physicians, nurses, billing personnel, outside billing companies, administrators, contractors, and other individuals with different responsibilities.
The fact that an improper claim was submitted does not necessarily establish that every person associated with the claim knowingly participated in fraud.
A Tampa healthcare fraud defense attorney can examine who was responsible for the billing decision, what information was available, what the defendant understood, and whether the government’s evidence actually establishes knowing participation in a fraudulent scheme.
Grand Jury Subpoenas in Healthcare Fraud Investigations
Grand jury subpoenas are commonly used during federal healthcare fraud investigations.
A subpoena may request:
- Patient records
- Billing records
- Medicare and Medicaid claims
- Financial records
- Emails
- Text messages
- Referral agreements
- Employment records
- Contracts
- Prescription records
- Corporate records
- Electronic communications
Receiving a grand jury subpoena does not necessarily mean that you will be charged with a federal crime. However, it can indicate that a serious federal investigation is underway.
Counsel can review the subpoena, communicate with federal prosecutors, address document preservation, evaluate privilege issues, and determine how to respond appropriately.
Search Warrants and Federal Healthcare Investigations
Some healthcare fraud investigations involve federal agents executing search warrants at medical offices, businesses, or residences.
Agents may seize computers, mobile devices, patient files, financial records, and other potential evidence.
If federal agents execute a search warrant, you should avoid interfering with the search. You also generally are not required to provide an immediate substantive explanation of the allegations.
Contacting experienced federal criminal defense counsel promptly can allow an attorney to determine which agencies are involved, communicate with investigators and prosecutors, and begin evaluating the government’s case.
Healthcare Fraud, Kickbacks, and Referral Arrangements
Federal healthcare investigations may also focus on financial relationships between medical providers, laboratories, pharmacies, marketers, durable medical equipment companies, and other businesses.
The government may investigate whether payments or other benefits were offered or received in connection with patient referrals or services reimbursed by federal healthcare programs.
These cases can involve complicated business relationships and financial arrangements. A careful analysis of contracts, payments, communications, referral practices, and the applicable federal statutes may be necessary to determine whether criminal conduct occurred.
How a Tampa Healthcare Fraud Defense Attorney Can Help
Federal healthcare fraud cases can combine complicated medical, financial, regulatory, and criminal issues.
Attorney Petro carefully evaluates the government’s evidence and develops a defense strategy based on the circumstances of each case.
Representation may include:
- Communicating with federal investigators and prosecutors
- Determining whether a client is considered a witness, subject, or target
- Responding to grand jury subpoenas
- Reviewing healthcare billing and financial records
- Evaluating search warrants
- Reviewing electronic evidence
- Investigating the government’s allegations
- Examining evidence concerning knowledge and intent
- Identifying potential constitutional violations
- Filing appropriate pretrial motions
- Challenging the admissibility of evidence
- Negotiating with federal prosecutors
- Preparing for federal trial
- Advocating at sentencing
- Pursuing appropriate federal appeals
Early representation can be particularly important because decisions made during an investigation may affect how the case develops.
Experienced Healthcare Fraud Defense Representation in Tampa
Being investigated for healthcare fraud does not mean that you committed a federal crime. Likewise, an indictment is an accusation and does not establish guilt. The government bears the burden of proving the charges beyond a reasonable doubt.
Michael J. Petro provides experienced federal criminal defense representation to physicians, healthcare professionals, business owners, executives, and others facing healthcare fraud investigations and prosecutions.
If federal investigators have contacted you, you have received a grand jury subpoena, your medical practice or business has been searched, or you have been charged with healthcare fraud, consulting an experienced Tampa healthcare fraud defense attorney can help you understand your rights and the defense strategies available to you.
Contact Michael J. Petro to discuss your federal healthcare fraud investigation or criminal case.