Health Care Government Investigations Defense – What You Need To Know
If you’re a health care professional or business facing a government investigation, the stakes are high. These investigations often take a deep dive into billing practices, alleged fraud or compliance violations. They can threaten your license, livelihood, business and reputation.
At Strause Law Group, PLLC, we offer a staunch and strategic defense. Our experienced lawyers can guide you through the intimidating landscape of health care government investigations defense. We will advocate for your interests with the utmost care and attention to detail. We work with clients in the health care industry throughout Kentucky and South Carolina.
Understanding Government Investigations In Health Care
Government investigations in the health care sector are typically initiated by agencies such as the Department of Justice (DOJ), the Office of Inspector General (OIG) or the Centers for Medicare & Medicaid Services (CMS). State-level agencies in Kentucky and South Carolina may also conduct probes into health care practices, often in coordination with federal investigations.
These investigations may be civil or criminal in nature. They may stem from whistleblower complaints, audits or data anomalies.
Common grounds for health care investigations include:
- Alleged violations of the federal False Claims Act (FCA)
- Suspected breaches of the Anti-Kickback Statute (AKS) or Stark Law
- Billing irregularities such as upcoding, unlawful referrals or medical necessity concerns
Depending on the nature of the investigation, health care providers may receive different types of legal requests, including an OIG subpoena, a civil investigative demand (CID) or a grand jury subpoena. Our health care investigations attorneys skillfully address all phases of the investigation and any subsequent proceedings.
Compliance Is Your First Line Of Defense
One of the most effective ways to avoid government scrutiny is through proactive compliance. We work with health care entities to develop and refine internal compliance programs that meet federal and state standards. This includes:
- Conducting internal audits and risk assessments
- Reviewing billing and coding practices
- Training staff on fraud prevention and regulatory obligations
- Ensuring proper documentation and reporting procedures
A strong compliance program not only reduces the risk of investigation but also demonstrates good faith if one occurs. If your organization is already under review, we can help assess your current compliance posture and identify areas of vulnerability.
Allegations Of Fraud And Misconduct
When the government suspects fraud or misconduct, the consequences can be severe. Allegations may include:
- Unlawful remuneration or kickbacks for patient referrals
- Billing fraud, such as charging for services not rendered
- Fraud involving Medicare/Medicaid
- Misrepresentation of medical necessity
- Self-referral violations under the federal Stark Law
These claims can result in civil penalties, exclusion from federal health programs, reputational damage and even criminal charges. Our health care fraud defense attorneys will work diligently to mitigate the impact of these investigations.
How We Defend Health Care Professionals
Our approach to health care government investigations defense is both aggressive and strategic. We begin by thoroughly reviewing the allegations, gathering evidence and identifying procedural or factual weaknesses in the government’s case. We assist clients in responding to subpoenas, preparing for interviews and negotiating with enforcement agencies.
We also represent clients in administrative hearings, civil litigation and criminal proceedings. We assist with preparing strategic OIG subpoena responses, kickback defenses and False Claims Act defenses, among others. We represent:
- Physicians and physician groups
- Hospitals
- Medical device companies
- Pharmacies and pharmaceutical companies
- Health care executives
- Hospice providers
- Chiropractors and chiropractic practices
Whether the issue involves a qui tam defense, OIG audits or Anti-Kickback Statute defense, we bring the knowledge and experience that our clients rely on.
Why Choose Us For Your Health Care Investigation Defense?
We are a family-run firm with a commitment to excellence in health care investigation defense. Our health care investigations attorneys have a longstanding reputation for solving complex legal problems in the boardroom, government hallways and courtrooms. We stand on decades of combined experience in regulatory defense, litigation and health care law. We understand the nuances of federal and state investigations, and know how to protect your interests when your practice or business is under scrutiny.
Frequently Asked Questions About Health Care Investigations
If you’ve received notice of an investigation or suspect one may be underway, it’s important to be informed. Here are answers to common questions about these situations:
What should I do if the government is investigating my health care practice?
First, do not speak to investigators without legal counsel. Preserve all relevant documents and communications, and contact a health care investigations attorney immediately. Early legal intervention can help you avoid missteps and protect your rights. An attorney can also help you understand the scope of the investigation, prepare your response strategy and communicate with government agencies on your behalf. Acting quickly can make a critical difference in the outcome of your case.
What are the potential penalties for a health care government investigation?
Penalties vary depending on the nature of the investigation. Civil cases may result in fines, repayment obligations, exclusion from Medicare/Medicaid and disciplinary action against your professional license. Criminal cases can lead to imprisonment, significant fines, license revocation and permanent damage to your career. Even informal investigations can have serious reputational consequences.
How can an attorney help me if a government investigation is threatening my career?
An experienced attorney can assess the scope of the investigation, advise you on your rights and develop a defense strategy. We help clients understand the nature of the allegations, respond appropriately to subpoenas or investigative demands, and avoid making statements that could be used against them. Our team also works to negotiate with government agencies for a favorable resolution whenever possible. We can identify procedural errors, investigative overreaching, evidentiary insufficiency and other grounds for challenging the allegations. Additionally, we can defend you in any disciplinary proceedings impacting your professional licensure.
In many cases, early legal intervention can prevent escalation, protect your professional license and preserve your reputation. We will work tirelessly to safeguard your career and your future.
Let’s Protect Your Practice – Before It’s Too Late
If you’re facing a government investigation or want to strengthen your compliance program, we’re here to help. At Strause Law Group, PLLC, we understand the pressure health care professionals face and the complexity of defending against regulatory scrutiny. Let us help you protect what you’ve built.
Schedule a confidential consultation today by calling one of the numbers below or sending a quick email.
Louisville office: 502-498-8268
Lexington office: 859-428-7029
Charleston office: 843-936-4846