When you learn that a federal investigation related to healthcare fraud is targeting your business or practice, it’s crucial to act swiftly and wisely. Investigations under 18 USC 1347 (False Claims Act), medical necessity disputes, Anti-Kickback Statute violations, Stark Law issues, and HHS-OIG inquiries can lead to severe consequences, including hefty fines and imprisonment.
Investigations often begin with a tip from a whistleblower or through routine audits that uncover discrepancies. Federal agencies such as the Department of Justice (DOJ), FBI, Office of Inspector General (OIG) at Health and Human Services (HHS), and Centers for Medicare & Medicaid Services (CMS) are typically involved.
The first 48 hours after learning about an investigation is a critical window. In this period, you should:
- Contact legal counsel specializing in healthcare fraud defense immediately to understand your rights and obligations.
- Ensure that no one within the organization destroys or alters documents related to the investigation.
- Avoid making statements to investigators without an attorney present unless required by law.
Hiring experienced counsel early is essential. They can work with you to navigate regulatory requirements, mitigate risks, and protect your interests throughout the process. Early intervention may also open up opportunities for negotiation or resolution that might not be available later in the investigation.
What NOT To Do
- Avoid attempting to handle the situation alone or relying solely on internal legal advice.
- Do not destroy, alter, hide, or tamper with documents. Doing so can lead to additional charges of obstruction of justice under 18 U.S.C. § 1512(c).
- Do not make public statements about the investigation without consulting your attorney first.
Preserving relevant documents is crucial. This includes emails, patient records, financial statements, and any communications with government agencies or regulators. You should:
- Identify all potentially relevant documents using keywords related to the allegations.
- Instruct employees not to delete or alter these documents.
- Consider retaining an outside forensic accounting firm if there are financial records at issue.
Taking proactive steps and seeking expert legal advice early on can significantly influence the outcome of a healthcare fraud investigation. Remember, navigating these waters without proper guidance increases your risk of making costly mistakes that could jeopardize your future.