Lynette Byrd
Lead Attorney Lynette Byrd

What is a Medicare investigation?

If you are a healthcare provider enrolled in Medicare, then you are allowed to provide services to Medicare beneficiaries and then bill the federal government for payment of these services. If the federal government believes you are billing improperly or improperly providing services to Medicare patients, you are at risk for a Medicare investigation.

How Do I Know if I am Under Investigation?

You can be put on notice for allegations of Medicare fraud in a number of ways. You may receive a Grand Jury Subpoena. If you receive a subpoena, you will be required to produce documents and records to the government. Federal agents may show up at your place of business or house. If federal agents show up, they usually will request to interview you and your staff regarding any allegations of fraud. Unfortunately, sometimes you will not know if you are under investigation until a there is a criminal complaint or criminal indictment.

Should I Speak with Federal Agents if They Come to My Business?

As a general rule, no you should never speak to federal agents without an attorney present. Federal agents do not have your best interests in mind and only want to speak with you or your staff in order to bolster the allegations they already have against you. If a federal agent comes to your house or to your business, kindly take their card and tell them you will not be speaking with them until you consult with your attorney. Agents may try to pressure you into speaking, but always remember, you are not obligated to speak with them. To makes matters worse, it is a federal crime to lie to a federal agent. So, if you do decide to speak with an agent and you are caught lying, you can be charged with a crime.

What Happens After I am Under Investigation?

If you are under investigation for Medicare fraud, you must consult an attorney immediately. Getting out in front of an investigation is the best possible way to avoid the investigation from escalating. Proactively handling an investigation can significantly reduce your potential criminal or civil exposure. By engaging an attorney, you can start to fight back against any allegations that have been levied upon you. Remember, Medicare investigations are serious and pose significant risk for you and your business. If you are under investigation, this investigation simply will not resolve on its own. You need an attorney to figure out what you are being investigated for, and then employ a defense strategy to resolve any allegations against you in a positive way. Do not try to handle an investigation on your own. Medicare is a complex web of nuanced legal rules and regulations and your healthcare attorney will be experienced in navigating this web.

What Am I Under Investigation For?

There are numerous ways to be under a Medicare investigation. Generally, Medicare investigations focus on billing practices and patient care practices. If you are billing for services incorrectly, billing for services not provided or intentionally overbilling claims you can be at risk for a Medicare investigation. Also, if investigators have cause to believe you are billing for medically unnecessary services, they can investigate you. If you are a Medicare provider, you agree to be bound by several federal healthcare laws. As a Medicare provider, you cannot pay for the referral of patients. You also cannot receive any sort of kickback, whether direct or indirect for furnishing services to Medicare beneficiaries. You also cannot refer patients to any entity in which you or an immediate family member has a financial interest. Compliance with these federal healthcare laws is often difficult to discern. Unfortunately, if you violate a federal healthcare law, you can be put under investigation and possibly charged with a crime.

How Do I Fight a Medicare Investigation?

You must be proactive to fight a Medicare investigation. Do not ignore the fact you are under investigation with the hope the investigation will simply go away. Hire an attorney immediately once you know you are under investigation. If an investigation is left unchecked, you face likely criminal or civil liability. Punishment for criminal violations of healthcare laws can be severe. An attorney can identify the reasons you are under investigation, activate corrective measures to help you be in compliance with all federal healthcare laws and work with federal authorities to mitigate any potential criminal or civil exposure you may have.

What Kind of Attorney Should I Hire?

Medicare investigations deal with highly complex sets of rules and regulations. You need to hire an attorney who is experienced in the healthcare filed and understands the nuances of federal law. If you are seeking a divorce, you obviously will hire a divorce attorney. If you are dealing with a healthcare matter, you should hire a healthcare attorney. Do not leave your liberty and livelihood up to chance if you are involved in a Medicare investigation. Engage an attorney who is properly equipped to handle a Medicare investigation matter.

At our firm, we have decades of experience defending against Medicare investigations. We employ a team of former Department of Justice individuals along with a team of former federal agents. We not only understand how healthcare laws work, we understand how the government thinks. Knowing how the other side operates gives us an advantage in defending our clients. We dedicate our practice to helping healthcare providers. We understand mistake can be made and just because you are accused of something, that does not automatically make you guilty. We fight for your rights in order so you can continue doing what you do best.