Healthcare Fraud - Criminal Investigation (CI)



Criminal Investigation investigates healthcare fraud perpetrated against the federal and state governments, as well as private insurance companies. In these investigations, CI follows the money trail and considers both tax and money laundering perspectives. Criminal tax investigations are initiated when income generated from healthcare fraud is not correctly reported on tax returns, or when there is an overstatement of expenses on tax returns. Criminal Investigation investigates money laundering when either illegally obtained funds from healthcare fraud are used to purchase assets or when the perpetrators of the schemes devise elaborate methods to conceal their fraudulent proceeds. Money laundering occurs in a wide range of fraudulent healthcare schemes such as false claims, kickbacks, or staged accidents.

Typical healthcare fraud investigations are lengthy, labor intensive, and involve complex issues. To assist in combating healthcare fraud, CI participates in DOJ-sponsored, multi-agency task forces and works closely with several state agencies. These task forces capitalize on the strength and expertise of the participating agencies and have proven effective in dealing with healthcare fraud.

Criminal Investigation’s participation enhances multi-agency healthcare fraud investigations by documenting that the perpetrators of these schemes financially benefited from their fraudulent activities. Currently, CI is involved in the following areas of healthcare fraud: false billings, mental health, nursing home fraud, chiropractic fraud, durable medical equipment fraud, staged accidents, pharmaceutical diversion, and patient referral (kickbacks) schemes.

Statistical Data
Healthcare Fraud enforcement statistics on investigations initiated, prosecutions recommended, indictments, sentenced investigations and months to serve in prison.

Examples of Healthcare Fraud Investigations
Examples of investigations have been written from public record documents filed in the district courts where the case was prosecuted.


How to Report Suspected Tax Fraud Activities