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Health Care Fraud & Prescription Fraud

January 7, 2025

Legal Matters Involving Health Care Fraud and Prescription Fraud and How to Respond

Health care and prescription fraud, also known as pharmacy fraud, are serious legal matters. If you’ve recently become the target of a federal criminal investigation, you’ll need to act quickly. Hiring a competent federal criminal defense attorney should be the first thing on your priority list. If you’ve already been arrested, it’s critical that you retain an attorney as soon as possible. Making statements to the DEA, the Medicaid Fraud Control Unit, local authorities, or even the department of health can have devastating effects on your case. This informative article will explain the different types of fraud, the potential consequences of committing fraud, and how an attorney can help.

How to Determine if You’re Under Investigation and How to Handle the Matter

There are several ways that you’ll find out that you’ve been or will be under investigation for healthcare or prescription fraud. Perhaps the most prominent way is by having a search warrant for your home or place of business or a DEA or local law enforcement officer shows up. This is typically done at the most inconvenient time of day where the agents will most likely find you. A “target letter” is a letter from the prosecuting attorney for the agency that puts you on notice that you’re under investigation. This may also be accompanied with or is substituted with a subpoena to turn over information, evidence, and records. It’s also possible for your co-workers and even friends and family to be targeted by questioning agents. Agents have been known to approach you at home or work to question you as well. While there are a few other ways, these are among the most common.

Talking to the agent is never a good idea. Their job as law enforcement is to investigate and potentially charge you with a crime. Agents are skilled investigators that will utilize a variety of tactics to lead you into self-incrimination. In this scenario, it’s better to not speak until you’ve retained an attorney to assist you with the interrogation process. Even the most seemingly innocent questions can be used against you if they yield valuable information for the investigator.

Common Types of Healthcare and Prescription Fraud

Healthcare fraud and prescription fraud tend to have some overlapping characteristics. Since these are typically considered to be “white collar” crimes, money is usually involved in one way or another. Overbilling, ghost billing, accepting bribes or “kickbacks,” and refilling scripts without permission are also incredibly common matters that involve money. These issues also often give rise to insurance fraud, so it’s incredibly wise to ensure that thorough recordkeeping practices are in place if the alleged crime hasn’t taken place.

The DEA also monitors for drug diversion from pharmacies that are essentially supplying street-level dealers. This has become a huge concern within the last decade and is an epidemic. In this scenario, hiring a highly skilled federal criminal defense attorney is an absolute must.

Time is of the Essence, Retain an Attorney, Today!

If you’re aware that you’re the target of an investigation or if you’ve been arrested due to an investigation, contact an attorney at once. Handling these matters on your own can result in significant jail time and financial penalties. While the courts allow for pro se litigants, no sympathy for lack of knowledge or experience is given. A skilled federal criminal defense attorney can put together a game plan that’ll significantly reduce your penalties or avoid them altogether. Get in touch with our offices, and an attorney will review your case to determine the best course of action for the matter.

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Todd Spodek

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RALPH P. FRANCHO, JR

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JEREMY FEIGENBAUM

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ELIZABETH GARVEY

Associate

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CLAIRE BANKS

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RAJESH BARUA

Of-Counsel

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CHAD LEWIN

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