Fraud and Abuse Investigations

Our healthcare lawyers counsel and represent physicians and healthcare business owners in connection with a variety of fraud and abuse investigations and related matters. To healthcare lawyers, “fraud and abuse,” in the context of healthcare delivery, generally speaking, alludes to a variety of circumstances that might implicate Federal and/or state law or regulations that prohibit certain types of health care services or items provided more for improper remuneration or financial incentives rather than to promote good healthcare.

Atlanta and Augusta, Georgia Healthcare Law Offices

Our healthcare law firm represents and defends healthcare providers with regard to investigations and civil law enforcement actions concerning, for example:

  • Medicare Audits and Fraud Investigations
  • Medicaid Audits and Fraud Investigations
  • OIG, FBI, CMS and HHS Investigations
  • Corporate Integrity Agreements
  • State Law Enforcement Investigations
  • Medical Board Investigations
  • Section 340B HRSA Audits
  • Section 340B Drug Manufacturer Audits
  • Grant Fraud
  • False Claims Act Investigations and Cases
  • Whistleblower Matters
  • DEA investigations
  • NPDB matters
  • Third Party Payer Audits and Legal Action

A physician, other healthcare provider, or healthcare business owner may be contacted by Federal or state law enforcement, or a contractor acting on their behalf, at a time when counsel has not been retained. Because ensuing communications will necessarily have critical implications as part of a government investigation, often it is imperative that qualified legal counsel be consulted before any communications with law enforcement. Many healthcare providers have been prosecuted for statements made during investigations before retaining counsel, in addition to (and, sometimes, rather than) the underlying matter investigated. For this reason, when a physician, other healthcare provider, or healthcare business owner receives a letter or call indicating a desire by law enforcement to make inquiry, the next call should be to his or her attorney.

Fraud and Abuse: A National Crisis

For many years, healthcare fraud and abuse has been a national crisis that affects every taxpayer. National data indicates that, annually, billions of dollars are lost as a result of various types of fraud and abuse, including the following categories of fraud and abuse by providers:

  • Billing for services not provided
  • Charging more for services than allowed by law (“upcoding”)
  • Falsely representing the actual service provided
  • Duplicate billing
  • Billing for uncovered services
  • Kickbacks and other illegal remuneration to incentivize unnecessary healthcare services

Government law enforcement, both state and Federal, provide extensive information on websites regarding the subject of fraud and abuse. The OIG, for example, provides much information on its website about its law enforcement activities. Medicare.gov, as another example, provides extensive information about how to identify and report fraud.

Avoid the appearance of impropriety

An important aspect of fraud and abuse laws too often unknown to (or discounted by) physicians and other healthcare providers is that to have “your heart in the right place” may not insulate one from the adverse, and sometimes draconian, financial and professional consequences that can attend violations of certain fraud and abuse laws. Too often, physicians and other providers feel protected because a transaction, financial relationship or business arrangement is not intended by them to be dishonest or improper in any way. Unfortunately, the complexities of Federal and state regulatory law can be deceiving. Often, bad intentions are not required. For example, Federal self-referral law, known as Stark law, is a civil, strict liability statute that does not require wrong intentions to violate the law.

Contact Us

Our Georgia based law firm is available to answer your questions about fraud and abuse. If your medical practice or healthcare business is concerned about fraud and abuse issues or has received notification of law enforcement activity, we can assist you. Contact us today.