Healthcare providers, business owners, and medical professionals can find themselves in serious legal trouble when federal investigators suspect healthcare fraud may have taken place. Many are surprised to learn that investigations often start well before charges are laid. Sometimes, investigators will monitor records for months or even years before a person knows they are being watched. Getting in touch early with a Federal healthcare fraud attorney can help a person better understand the situation, protect their rights, and avoid mistakes during an investigation.
What Is a Federal Healthcare Fraud Investigation?
When the government suspects cheating, false billing, or financial wrongdoing involving healthcare, a federal healthcare fraud investigation takes place. These may include treatments, bills, insurance payments, prescriptions, referrals, or government health care programs.
The cases may be investigated by different government agencies, including the Federal Bureau of Investigation, the U.S. Department of Health and Human Services Office of Inspector General, the U.S. Department of Justice, or federal prosecutors. The cases may involve programs like Medicare or Medicaid.
Sometimes repeated billing mistakes, paperwork problems, or unusual billing patterns can lead investigators to look more closely. Sometimes, investigators have reason to believe someone intentionally billed for things that didn’t happen, ordered treatment that wasn’t needed, took illegal payments, or otherwise deliberately broke rules of healthcare billing.
What Usually Causes Investigators To Start Looking?
There are many reasons why a federal investigation may begin. Sometimes billing activity raises red flags. For example, a provider might unexpectedly bill for a large number of services, expensive treatments, or care that doesn’t seem usual for their patients.
Sometimes, suspected fraud is reported. It could be a current or former employee, business partner, patient, or even a competitor who tips off federal authorities about suspected wrongdoing. This can lead to audits, interviews, records requests, or subpoenas.
Audits can also result in investigations. Billing records and payment information are routinely reviewed by government programs and insurance companies. If something feels off or doesn’t quite fit, investigators may start to dig deeper.
A federal healthcare fraud attorney can help you understand what specific red flags may indicate if you receive a subpoena, audit request, records demand, or notice of investigation.
Can Billing Mistakes Lead To A Federal Investigation?
Sometimes, yes. Not every investigation begins with investigators believing someone acted intentionally.
Repeated billing errors, incorrect coding, duplicate claims, poor documentation, or billing for services that aren’t supported by medical records may attract attention. Sometimes, investigators want to know if errors were made accidentally or if there is evidence of fraud.
Also, healthcare fraud investigations are generally pattern-based. One problem might not merit a full investigation, but repeated problems and financial or other complaints might encourage more scrutiny.
The emails, patient records, payment information, contracts, and communications could be reviewed by federal investigators to figure out what happened.
What Are Common Warning Signs Of A Federal Investigation?
Sometimes people find out about an investigation when agents show up unannounced, or when a subpoena arrives. In other cases, warning signs appear earlier.
A provider may receive requests for records, audit notices, grand jury subpoenas, or requests for interviews. An investigator might suddenly interview employees. Your business partners or coworkers may be contacted by federal agencies.
Sometimes investigators will execute search warrants or seize records, computers or devices. Even if no charges have been filed, these are typically situations that are taken seriously because statements or actions early in an investigation can have an impact on the case later.
What Should Someone Do If They Believe They Are Being Investigated?
When people suspect a federal healthcare fraud investigation, they often feel scared or confused. Sometimes panic can lead to bad decisions, especially when someone speaks with investigators without fully understanding what’s going on.
It can be useful to stay calm, not destroy documents, not talk about the investigation casually with others, and understand what the investigators are asking before responding. Since federal healthcare fraud investigations can become very serious, getting legal guidance early may help someone avoid unnecessary mistakes.
If you believe you may be under investigation or have received a subpoena, audit notice, or request for records, speaking with a Federal healthcare fraud attorney may help you better understand your options. Aaron L. Wiley Law, P.C., represents clients facing serious federal investigations and defense matters. To discuss your situation, call Aaron L. Wiley Law, P.C. at (469) 770-3842 or reach out online.