Documenting Your Individual Role in a Healthcare Fraud Case

Separate title, authority and conduct

A job title describes a position. Authority describes what a person could decide. Conduct describes what the person actually did. Keep those categories separate. An owner may have delegated functions; an employee may have exercised substantial practical control. Neither conclusion should be assumed from the title.

Start with each role you held, its dates, reporting lines, responsibilities and source documents. Note changes in duties, periods of leave, business acquisitions and transitions between entities.

Map the process before writing the narrative

Follow the actual workflow: referral, clinical encounter or service, documentation, coding, approval, submission, payment and correction. Identify your involvement at each stage. Some cases require a different sequence; the map should describe the real operation.

• Who performed the task?
• Who approved or supervised it?
• Which system or account was used?
• What document records the action?
• Which dates and entities are covered?
• What remains uncertain or disputed?

This map is a preparation aid for counsel. It does not establish guilt, innocence, a role adjustment or the scope of a conspiracy.

Use a chronology with evidence labels

Each event should identify the date, your action, the source and the confidence level. Label a contemporaneous record differently from your present recollection. If a statement comes from another person, identify that source rather than presenting it as your personal knowledge.

Avoid descriptions such as “everyone knew,” “I had no control” or “the system did it” unless the specific facts support them. Replace generalizations with concrete questions: which approval was required, who held it, and what does the record show?

Document concerns and responses accurately

Where relevant, preserve records of questions raised, training received, instructions given, audits, corrections and changes in responsibility. Include the full sequence. A concern raised on one date should not be described as proof that an earlier problem was resolved. A policy written later should not be presented as a control that existed before it was implemented.

Do not contact witnesses, patients or former employees to align accounts. Counsel should direct any third-party contact and preservation questions. Keep your own recollection separate from materials you learn about later.

Accountability and disputed issues can be organized separately

Counsel should guide how you address admitted conduct, contested facts and unresolved allegations. An accurate personal account can describe your own decisions and documented corrective work without speculating about another person’s motives. A chronology should not be used to manufacture a blame-shifting narrative.

A hypothetical example: a clinician signed documentation while a separate vendor submitted claims. The file should identify the clinician’s actual review and signature process, the vendor relationship and the source records. That distinction creates questions for review; it does not answer the legal significance of either participant’s conduct.

Prepare a concise review packet

The packet can contain a one-page role summary, a longer dated chronology, a process map, an exhibit index and an open-questions list. Make it possible to trace every important sentence back to its source. Preserve corrections through version dates so counsel knows which draft is current.

Next, connect this history to PSR preparation and documented corrective work. Joseph can help build these materials within an agreed engagement.

Published analysis behind the preparation

Joseph De Gregorio is Founder and President of Sentencing Advocacy Group and a recurring published contributor to Bloomberg Law and Bloomberg Tax. The selections below connect his authored work to the preparation question on this page.

These publications address broader sentencing or financial-record preparation; they are not healthcare-specific clinical or billing opinions. Original article titles are retained as published. Publication does not imply publisher endorsement or a promised result.

Define the next step in your case

Request a private case review to discuss timing, preparation priorities and the scope of support. Defense counsel can use the attorney pathway to discuss a specific client or defined task.

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