The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS) works closely with the Centers for Medicare and Medicaid Services (CMS), Department of Justice (DOJ), and FBI.
Its purpose is to investigate matters related to payments billed to Medicare and Medicaid that may be fraudulent or inappropriate. The goal is to eliminate medical payment waste and recoup any payments made by means of fraud or deceptive billing practices.
If you believe you are the target of an OIG Investigation, you will need an attorney who specializes in defending health care entities and providers during OIG investigations.
Generally, an OIG investigation is not revealed until the company or provider is served with a subpoena to produce records or a search warrant. The best time to seek legal counsel upon receiving a subpoena is before any formal charges are brought.
OIG investigation reports often result in civil penalties, criminal charges, or both. Waiting until after charges have been brought against you puts your case in a disadvantage.
Retaining an OIG attorney during the investigation phase allows the attorney to oversee and shape the course of the investigation, which may result in fewer, or no, civil and criminal actions against you.
Preparing for an OIG Investigation starts long before the OIG begins to investigate. A proper compliance plan including policies and procedures, a compliance officer, routine auditing and monitoring is required for all entities that bill a federal health care program.
As part of a compliance program, providers looking to prepare and protect themselves prior to notice of an OIG investigation can conduct their own internal investigation to reveal billing errors and/or fraud. This enables a provider to stay proactive in a time when the OIG is cracking down on inappropriate medical billing.
An experienced OIG and health care attorney can help you conduct your own investigation and ensure that your rights are protected if you are investigated by the OIG.
An OIG investigation is usually concluded with a report detailing any violations and all facts gathered during the investigation.
If the report contains findings of any criminal violations it is forwarded to the Department of Justice (DOJ) for a further criminal investigation for health care fraud. If the violations are merely civil in nature, CMS may initiate an action to recover payments and impose civil penalties against the violating provider.
We represent providers and practices nationally during Medicare audits, Medicaid audits and third-party payor audits. Our team of Medicare and Medicaid audit attorneys has extensive experience in Medicare audits, including ZPIC, RAC, and Safeguard (PSC) audits.
Our offices are in Detroit (where we serve Dearborn, Troy, Ann Arbor and Grand Rapids, and the rest of Michigan); Miami and Sarasota, Florida (for Jacksonville, Tampa, Orlando, West Palm Beach, and all of Florida); Los Angeles/Southern California; and Chicago.
With lawyers dedicated to helping providers defend their claims during audits, recovery action and appeals, you are in strong hands. Contact us today to learn more.Instead of potentially facing charges under the False Claims Act, the provider was paid the governmental incentive for properly achieving meaningful use or the exclusions thereunder.
Here’s what health care providers and practices need to know about Medicare audits, Medicaid audits and third-party payor audits — and how our healthcare defense lawyers can help you.
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