Trenton Health Care Fraud Lawyer

Trenton Health Care Fraud Attorney

When you are accused of health care fraud allegations, it can threaten everything you worked for. Since Trenton is the capital of New Jersey, investigations often involve state-level agencies and federal authorities. A Trenton health care fraud lawyer is essential to protecting your future when your records, billing, or claim submissions are under scrutiny.

At Tim Anderson Law, we represent clients facing complex fraud concerns involving Medicare, Medicaid, private insurers, and electronic medical records. As a New Jersey criminal defense attorney and law firm with over 30 years of practice, we understand the rules and investigative tactics at both the state and federal levels. Our team focuses on preserving your financial stability and professional credibility.

How Health Care Fraud Investigations Start in Trenton

Federal and state enforcement efforts remain aggressive in New Jersey and across the country. According to the U.S. Department of Justice, the Centers for Medicare and Medicaid Services successfully prevented over $4 billion in false and fraudulent claims through investigative reviews.

Staying compliant is only part of the solution. Knowing how health care fraud investigations work and what to do during the process keeps you ahead of situations that may cost your professional life or freedom.

Common reasons for health care fraud investigations in Trenton include:

• Insurer audits
• Whistleblower reports
• Financial irregularities
• Referrals from federal agencies

When government agencies request documents, billing histories, or patient treatment records, an experienced attorney can help. They manage communication, preserve evidence, and clarify the scope of the review. If you are under investigation or receive an audit notice, hire a Trenton health care fraud lawyer before any statements or records are submitted.

Your Rights During an Audit or Subpoena

Health care spending in the U.S. remains high, and a health care fraud investigation brings unwanted attention to you or your practice. In a report from the American Medical Association, in 2023 alone, national costs totaled $4,866.5 trillion.

With that much money involved, health care fraud cases are a serious matter, and one innocent mistake might put you at risk for heavy fines or incarceration. Health care fraud cases usually involve an audit or a subpoena. However, not every investigation leads to punishment.

A health care audit is a routine review triggered by insurers to check for compliance or suspicious patterns. It doesn’t necessarily allege wrongdoing. A subpoena, on the other hand, comes from a government investigator or prosecutor. It requires you to produce documents, records, or even potential requests testimony. A subpoena usually signals that a review has escalated to possible criminal enforcement.

Common mistakes that trigger investigations include:

• Coding inaccuracies or upcoding
• Missing or incomplete patient documentation
• Poor record-keeping compliance
• Unclear billing justification

Speaking with a Trenton health care fraud attorney before responding to a subpoena or audit protects you from misclassifications or unfair conclusions.

Potential Defenses to Health Care Fraud

Many people facing fraud allegations have no criminal history. According to data provided by the United States Sentencing Commission, 90.4% of people sentenced in federal health care fraud cases had little or no prior criminal history.

Most penalties under New Jersey and federal health care fraud laws depend on the amount of money that was defrauded. Other important criteria include available evidence and whether investigators believe intent was involved.

Common outcomes for when a person is convicted include fines, restitution, and licensing actions. In severe cases, included high dollar fraud amounts, jail time is very possible. A strong defense makes the difference between protecting and losing your reputation and your freedom.

Potential defenses to health care fraud investigations in Trenton may include:

• Lack of criminal intent
• Administrative or coding errors
• Insufficient or unreliable evidence
• Challenges to billing decisions
• Limited documentation

If you have been contacted by investigators or insurers who believe you might have committed health care fraud, take action now. Speaking with an experienced attorney at Tim Anderson Law helps establish a defense before misunderstandings become allegations.

Why You Should Hire a Health Care Fraud Lawyer

Whether you are facing an audit, a subpoena, or a criminal investigation, hiring an experienced Trenton health care fraud attorney keeps you from making costly mistakes. The team at Tim Anderson Law understands what is at stake and challenges assumptions before the damage is done.

With over 30 years of defending complex white-collar cases across New Jersey and other states, Tim Anderson Law brings a high level of federal criminal defense experience to every health care fraud investigation. Our firm represents physicians, providers, and business owners at every stage from early inquiry to trial.

Our clients receive strategic, meticulous defense that is grounded in preparation, persuasion, and compassion. Tim Anderson Law is trusted statewide and beyond when the stakes are highest. If you are worried about health care fraud allegations, do not hesitate to call our offices today.

FAQs

Who Investigates Health Insurance Fraud in New Jersey?

In New Jersey, the agency that investigates health insurance fraud depends on the alleged misconduct. However, the Office of the State Comptroller’s Medicaid Fraud Division one of is the primary agency for matters in Trenton. Investigations usually start with an audit and only escalate when reports or documentation appear suspicious. For federal allegations, the U.S. Attorney’s Office for the District of New Jersey gets involved. If you are being investigated or believe an investigation is coming, hire a health care fraud attorney as soon as possible.

What Three Elements Are Required to Prove Fraud?

There are three elements that are required to prove fraud, which the prosecution would need to prove beyond a reasonable doubt. First, it must be proven that false or misleading information was submitted. Second, the defendant must have known the information was false. Finally, a prosecutor must prove that you intended to receive money. Showing intent is usually the most difficult to prove, and a Trenton health care fraud attorney understands defense strategies to fight the charges and keep you safe.

How Far Back Can Fraud Be Investigated?

The timeframe for how far back health care fraud cases can be investigated varies depending on the statutes involved. Some investigators look back several years to review patterns, billing trends, or records. In certain federal health care fraud cases, audits or subpoenas may involve documentation from five years ago or longer. Contact a Trenton health care fraud attorney to better understand your situation and protect your rights.

What Evidence Is Needed to Report Fraud in Trenton?

The evidence needed to report fraud in Trenton is usually documentation such as billing statements, email communication, and financial records. Screenshots or other images that show discrepancies are also used. Visual proof and witness statements are strong evidence when reporting fraud. However, prosecutors must connect this evidence to specific actions. They cannot base a case on assumptions or incomplete information.

Contact Tim Anderson Law Today

Health care fraud allegations can threaten your career, your freedom, and your future. Don’t risk losing your license or your freedom over a misunderstanding. If you are under investigation, you need experienced legal counsel.

With more than 30 years of defending complex white-collar cases, Tim Anderson Law provides strategic advocacy from the earliest stages of investigation through trial. If you are facing health care fraud concerns in Trenton or greater New Jersey, contact us today to protect your rights and your reputation.