Fraud and Abuse Investigations
Our health law firm represents medical practices, physicians and healthcare business owners in connection with a variety of fraud and abuse investigations and related matters. “Fraud and abuse,” in the context of healthcare delivery, generally 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.
Fraud Defense Health Law Firm
Our health law firm represents and defends medical practices, physicians and other healthcare providers with regard to investigations and civil law enforcement actions concerning, for example:
- Medicare 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 medical practice, physician, other healthcare providers, 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 ensuring communications will necessarily have critical implications as part of a government investigation, often it is imperative that qualified legal counsel is 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 providers, or healthcare business owner receives a letter or call indicating a desire by law enforcement to make an inquiry, the next call should be to his or her health law attorney.
Fraud and Abuse: A National Crisis
For many years, healthcare fraud and abuse have 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.
Our health law firm is available to answer your questions about fraud and abuse issues. 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.