New York Federal Health Care Fraud Investigations

Health care fraud is taken very seriously by the government. Millions of dollars go missing as a result of fraudulent claims filed by healthcare professionals, and in some instances, patients themselves. As a result of this waste, the government is now taking a more stringent and aggressive approach to New York health care fraud investigations, as well as the charges themselves. That is why it is important to contact an attorney. If you have been charged with healthcare fraud, get in touch with a qualified federal health care fraud lawyer that can work tirelessly to make your case.

Dynamics of  Healthcare Fraud Investigations

Usually, New York federal health care fraud investigations are done by the FBI, which is primarily charged on the federal side with handling health care fraud investigations. The investigations can be handled in a number of different ways. Sometimes, the FBI will recruit undercover or confidential sources to help them out. Sometimes, they can prove a case solely using medical records and other documents, including telephone records, emails, and, prescription records.

Federal Agencies Involved in Investigations

As mentioned above, the main federal agency involved in investigating federal health care fraud. Of all of the federal agencies, the FBI are primarily with handling generalized federal health care fraud. State agencies would not handle federal fraud. That being said, state agencies handle the state side of Medicaid. For instance in New York, the New York State Department of Health has its own investigatory unit to handle state Medicaid fraud.

What Happens During the Course of an Investigation

Anything can happen during the course of New York federal health care fraud investigations. Once an investigation starts, they never really know what can turn up especially if an individual does not have a lawyer from the get-go. If the government freely can go into either a healthcare organization or an insurance company and start looking for fraud, they never know what else they will turn. Really, anything can happen in one of these investigations once the floodgate’s open.

Evidence the Government Uses to Prove Fraud

The evidence that the government uses to prove elements in New York federal health care fraud investigations includes:

• Wiretaps
• In person recordings
• Undercover agents
• Emails
• Health care documents
• Photographs
• Receipts/medical bills

Triggers for Federal Healthcare Fraud Investigations

Federal healthcare fraud investigations rarely begin at random. In most cases, investigators notice billing activity or complaints that suggest possible fraud. Some of the circumstances that can lead to federal healthcare fraud investigations in New York include the following.

Unusual Billing Patterns

Billing irregularities frequently trigger federal investigations. Investigators may look for providers who bill for unusually high numbers of procedures or services that appear medically unnecessary. Repeated claims for the same treatment or billing for impossible appointment schedules can also attract attention to potential fraud.

Federal agencies often use data analysis software to compare providers against others in the same field. If a clinic’s billing patterns fall far outside the normal range, investigators may begin reviewing records more closely. Of course, when prosecutors blindly rely on this data, it can lead to charges in cases where fraud had not occurred.

Whistleblower Complaints

Many investigations of federal healthcare fraud in NYC begin with reports of suspected fraud to federal authorities. More often than not, they involve someone with inside information regarding the alleged act of fraud. A report might come from a co-worker, employee, or even a competitor.

Insurance Audits

An insurance audit may start as a routine review but later become a criminal investigation. Medicare, Medicaid, and private insurers regularly examine billing records to identify suspicious claims or overpayments. When the signs of fraud become too big to ignore, this can lead to an investigation. If auditors believe a provider intentionally submitted false information or billed for services that never occurred, they may refer the matter to federal law enforcement agencies.

Patient or Employee Reports

Patients and employees often notice problems before investigators become involved. Complaints about fake diagnoses, unnecessary procedures, forged records, or even billing for services never received may trigger an investigation on the federal level.

Even a single complaint can lead investigators to dig into financial and medical documents to determine if fraud occurred. Once federal authorities begin investigating, they often look far beyond the original allegation that started the inquiry.

Evidence the Government Uses to Prove Fraud

Federal prosecutors often build health care fraud cases using a large amount of financial, electronic, and surveillance evidence. In many investigations, the government spends months collecting records and monitoring communications before filing criminal charges. Some of the evidence that could be used in a healthcare fraud investigation in New York include:

• Wiretaps
• In person recordings
• Undercover agents
• Emails
• Health care documents
• Photographs
• Receipts/medical bills

Federal agencies may combine several forms of evidence to create a timeline of alleged fraud. If you are concerned about the proof the government intends to use against you, it may be time to discuss your defense with our firm.

Importance of an Experienced Attorney

These cases are extremely complex. The statutes are very complex. Federal cases alone are complicated, and because they involve the government, they often carry higher penalties. There is a lot on the line during New York federal health care fraud investigations, which is why it is vital that you contact a lawyer who is familiar with healthcare fraud cases. A seasoned fraud attorney can hire a private investigator that can look into your case and gather evidence of their own. The attorney can anticipate the kind of arguments that the prosecution can make, and craft a defense that can weaken the prosecution’s argument.  Most importantly, an experienced healthcare fraud lawyer can fight for you.

Discuss Your Federal Healthcare Fraud Investigation With a New York Attorney

Our firm has a long track record of success when it comes to fighting federal charges, and we understand how investigations work at this level. Whether you’ve already been charged or have recently been notified of an ongoing investigation, you deserve legal counsel who knows how to protect you.

It’s in your best interest to move quickly after learning of an investigation. In some situations, it may be possible to resolve things without charges being filed. Call today for a private consultation to discuss your New York federal healthcare fraud investigation.