Over recent years, the federal government has shown an increased interest in bringing healthcare fraud prosecutions. In fact, in 2020 alone, the federal government opened 1,148 new criminal healthcare fraud investigations, recouping more than $1.8 billion in healthcare fraud judgments and settlements. This aggressive approach has not only uncovered countless healthcare fraud schemes but also subjected innocent providers to the burdens of dealing with a Detroit healthcare fraud investigation and prosecution. Given the high stakes in these prosecutions, if your business or practice is under investigation, it is imperative that you seek the counsel of an experienced Detroit healthcare fraud defense attorney.

What Is Healthcare Fraud?

Healthcare fraud is a sort of white-collar crime that entails filing false medical claims in order to make a profit. Fraudulent healthcare schemes exist in a variety of shapes and sizes and members can commit healthcare fraud by lying on applications for programs or services, counterfeiting or selling prescriptions, using transportation benefits for non-medical purposes, and borrowing or using another's insurance card.

The healthcare fraud laws in the United States are extremely broad; however, at their most basic level, they prohibit providers and certain other parties from obtaining or attempting to obtain money or other items of value from a healthcare company or federal government program through false and fraudulent representations. In the vast majority of criminal healthcare fraud cases, the government must prove not only that some error occurred, but also that it was intentional. Absent this proof of intent, a provider can still be liable for civil healthcare fraud, but not criminal charges.

While there are many types of conduct that fall within the term healthcare fraud, many healthcare fraud cases involve prohibited referral relationships and false or fraudulent billings.

Defending Against Detroit Healthcare Fraud Charges

The thought of mounting a defense to federal healthcare charges can be overwhelming, to say the least. However, Detroit healthcare fraud attorneys have developed a tried-and-true method of dealing with these complex cases. Below are a few of the basics when it comes to defending against federal healthcare charges in Detroit, Michigan.

Determine the Nature of the Offenses

Some healthcare fraud allegations are easy to understand. For example, the Department of Justice may claim that your practice submitted a pattern of fraudulent billing and reimbursement requests. However, rarely is the factual basis of a healthcare fraud claim that straightforward. Often, healthcare fraud cases involve long investigations, thousands of pages of documents, interviews, interrogatories, and more. The first step to effectively defending against Detroit healthcare fraud charges is to understand exactly what the government claims you did wrong.

Be Careful Who You Talk To

The next important thing to keep in mind isn’t so much something you should do, but something you should not do. Once the government announces that it is bringing healthcare fraud charges, it is often the culmination of a lengthy investigation. However, as the person being charged, you are only aware of the outcome of that investigation. In other words, you do not know who provided the government with the information that triggered the investigation, who else they spoke to in search of corroborating evidence, and what documents they have in hand.

That being the case, it is critical that you do not reach out to others who may be tangentially involved in an effort to coordinate a response strategy. It is very possible that they have already spoken with investigators or prosecutors and may have even been the source of some of the evidence against you.

Similarly, although it is unlikely that investigators will contact you once charges are filed, if they do, remember you are under no obligation to speak to them. The same goes for prosecutors.

Preserve All Potentially Relevant Evidence

Perhaps the best way to make your situation turn from bad to worse is to attempt to hide, destroy or alter evidence. The moment you become aware of a pending federal case, you are under an obligation to preserve all potentially relevant evidence. While you may not know exactly what is relevant, it is better to err on the side of assuming that evidence is relevant—until you speak with a Detroit healthcare fraud defense attorney.

The destruction, alteration, or hiding of evidence—or even the attempt to do any of these—can not only result in an adverse inference being made against you but can also form the basis of additional federal charges.

Federal healthcare fraud defense attorney Nick Oberheiden explains,

It’s certainly an understandable temptation for a provider to get rid of evidence that they think hurts their case. However, doing so is never a good idea. First, you cannot know what evidence the prosecution already has in its file, so destroying evidence may have no effect on the case. Second, if the government learns that you hid, altered, or destroyed evidence, you are likely looking at obstruction of justice or tampering with evidence charges. Even if the situation doesn’t rise to that level, if your case goes to trial, the prosecution will likely ask for an adverse inference. This means that the jury would be instructed that, had the evidence been preserved, it would not have been favorable to your case.”

Avoid Running to the Negotiation Table

Once you learn about the charges you face and the penalties they carry, it may be tempting to approach prosecutors looking for a negotiated offer. While it is true that many healthcare fraud cases do not end up going to trial, it is usually a mistake to begin the negotiation process too early. When you seek an offer for reduced charges or a reduced sentence from prosecutors, it sends the message that you believe you are guilty, even if that is not the case. The better alternative is usually to refrain from entering negotiations until you’ve spoken with an experienced Detroit federal healthcare fraud defense lawyer and allowed them to dig into your case to identify all possible defenses. While the federal prosecutors that bring these cases are highly experienced, there is a chance they missed something critical that could impact their case at trial.

Contact an Experienced Detroit Federal Healthcare Fraud Lawyer

The most important thing you can do once you learn of pending healthcare fraud charges is to reach out to an experienced Detroit federal healthcare fraud defense lawyer. When you are reviewing your options, remember to select an attorney who has extensive, hands-on experience handling the type of case you are facing. You may also be able to find a lawyer who previously prosecuted healthcare fraud cases on behalf of the government, giving them valuable insight into how these cases proceed through the system and the best ways of defending against them.