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DOJ Targeting Individuals in Health Care Fraud Investigations

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The federal government is continuing to develop new tools for its fight against Medicare, Tricare, and other forms of healthcare fraud. While the Department of Justice (DOJ) and other agencies have been stepping up their enforcement efforts for years, Deputy Attorney General Sally Yates’ recent announcement that the DOJ will be enhancing its focus on holding individuals responsible for corporate misdeeds should serve as a wake-up call for any healthcare executives and other individuals whose companies may be exposed to federal investigations.

The “Yates Memo” Confirms Government’s Focus on Individual Responsibility

Healthcare fraud remains a top priority of many federal law enforcement agencies. Falsified records, physician and patient kickback schemes, upcoding, and a number of other fraudulent practices are costing federal benefit programs like Medicare and Tricare billions of dollars every year. While these are all undoubtedly very real problems, the government’s wide-ranging approach to its enforcement efforts is also forcing many innocent healthcare providers to defend against invasive investigations and unsubstantiated allegations.

Healthcare executives and other individuals who engage in fraudulent conduct have long faced the possibility of jail time and personal financial liability. Now, however, it is clear that the DOJ intends to ramp up its efforts to hold individuals personally responsible.

In what has come to be called the “Yates Memorandum,” Deputy Attorney General Sally Yates outlined six principles that federal investigators and government attorneys are expected to follow when pursuing cases of alleged healthcare fraud:

  • Corporations must provide all relevant facts about individuals’ involvement in corporate fraud schemes, in order to be eligible for any cooperation credit;
  • Both civil and criminal investigations should focus on both the corporation and the relevant individuals from the outset of the investigation;
  • Government attorneys handling criminal and civil investigations should maintain routine contact with one another;
  • Corporate resolutions should not insulate individuals from liability, except in extraordinary circumstances;
  • Corporate fraud cases should not be resolved without a “clear plan” to resolve related cases against involved individuals, as well; and,
  • In civil cases, the government’s attorneys should focus on both corporate and individual accountability, and should not focus solely on whether an individual will be able to pay any fines or restitution incurred.

In other words, individuals who take part in perpetrating healthcare fraud can now expect to be central targets in federal government investigations.

Defending Against Allegations of Healthcare Fraud

If you are being investigated for healthcare fraud, what should you do? The simple answer is that you need to seek legal help as soon as possible. With your freedom and personal assets potentially at stake, you cannot afford not to take action.

When defending individuals in healthcare fraud investigations, we take a comprehensive approach designed to avoid all civil and criminal liability. In many cases, our defense strategy centers on convincing the government’s attorneys that any improper conduct is the result of a simple oversight or honest mistake. The government has the burden to prove an individual’s responsibility, and our experienced defense lawyers and former federal prosecutors will seek to raise as many questions about the government’s case as possible.

Speak with a Federal Healthcare Fraud Defense Attorney Today

If you are facing a federal healthcare fraud investigation, we urge you to contact us for a free case evaluation right away. We can help you understand the risks involved and the options that you may have available, and we can deploy our Emergency Defense Package to help you immediately begin defending against the government’s investigation. To speak with one of our senior healthcare fraud defense lawyers, call (800) 701-7249 or request your free consultation online now.

This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Reading of this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. Oberheiden, P.C. is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.
Orange County 714-294-2000
Los Angeles 310-873-8140
Detroit 313-888-8807
Nationwide 888-452-2503