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Former Assistant District Attorney
Former Assistant U.S. Attorney

What does a healthcare fraud investigation look like?

| Jun 30, 2021 | Uncategorized

As someone working in the healthcare field in Mississippi, you know how important it is that you take every aspect of the job seriously. Unfortunately, healthcare fraud is becoming more and more prevalent, and even if you have done nothing to put your trustworthiness into question, you could still find yourself a person of interest in an investigation. 

Though investigators may only want to ask you and others in the workplace some questions, it is still wise to understand what typically takes place during a fraud investigation. Additionally, you may want to remember that you have legal rights, and if you believe that investigators suspect you of fraudulent activity, understanding those legal rights and having legal support from the start may prove to be in your best interest. 

What does an investigation entail? 

Fraud investigations have various steps, and each investigation differs, depending on the type of fraud suspected and the parties involved. Still, an investigation into your practice or place of employment could include the following steps: 

  • Authorities receiving and reacting to an allegation, which commonly come from employees providing tips regarding illegal activity 
  • Creating an investigative team, which could happen with an internal investigation or if outside parties, like the FBI, conduct an external investigation 
  • Carrying out a preliminary assessment of the situation, which could include gathering of facts relating to the allegations and determining necessary courses of action 
  • Collecting evidence relating to the case, which could include files, financial records and emails 
  • Conducting employee interviews to gather more information 

In some cases, these investigations can begin internally, and then one may contact outside investigators or law enforcement to take the situation further. It is possible for serious criminal charges for healthcare fraud to result if the investigation points toward criminal activity. 

What can you do? 

At the first sign of an investigation, you may want to go ahead and ensure that you understand your legal options. If the situation is informal, you may not think that you need to take the situation seriously, but it is still important to remember that any information you provide could be of use against you later. If you have concerns that your legal rights have faced violation or that you could be a suspect in a criminal fraud scheme, you may want to start looking into your options for handling the situation.