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Protecting Yourself When You Are Targeted by an OIG Enforcement Action

Protecting Yourself When You Are Targeted by an OIG Enforcement Action

The Office of Inspector General tackles a wide range of fraudulent activity and abuse. It’s the largest inspector general’s office in the United States government, and the majority of its work is focused on Medicare and Medicaid. Unfortunately, these programs may be abused by healthcare providers, billing agents, and other professionals involved in this industry. Those who are affected are some of the most vulnerable individuals in our society.

If you have been caught in the crosshairs of an OIG inspection, you know that a lot is at stake. You should not go through this process without competent, aggressive representation. Call the Law Offices of Robin D. Perry at 562-216-2944 to set up a consultation with our healthcare fraud defense lawyers now.

What Causes an Investigation?

A number of actions can trigger an OIG investigation. In general, an investigation begins because the OIG receives data that indicates an increased risk of healthcare fraud. This data comes from billing data, Medicare/Medicaid program details from healthcare providers, and whistleblower tips. That means that if you are the subject of an investigation, there’s a good chance that someone close to your facility or to you personally has submitted a tip.

Why is this important to know? If you suspect that a whistleblower has triggered an investigation into your company or office, it’s crucial to avoid acting on that. Employees are legally protected from retaliation for whistleblowing.

Some actions that may lead to an investigation include:

  • Billing Medicare/Medicaid for services not rendered
  • Billing for more expensive services than those that were actually provided (also known as upcoding)
  • Billing both Medicare/Medicaid and private insurance for the same services
  • Billing for multiple services that should be bundled as one combined service
  • Compensation in exchange for referrals
  • Contracting with a service provider that engages in any illegal or fraudulent behaviors for your business

Steps to Take When You Are the Subject of an Investigation

When an investigation is forthcoming, you need to act quickly to minimize the damage, protect yourself, and protect the career you’ve worked so hard to build. The following steps can help you make the most of your time.

Look Into Your Compliance Programs

As a healthcare service provider, you should have in-depth compliance protocols in place to protect yourself from fraud. You may want to audit those programs and protocols to look for gaps. Is it possible that something slipped through the gaps? Is it possible that the accusations against you are true? For example, if billing only goes through one person and there’s no one verifying their work, could they be double billing and skimming some from the top? While changing your compliance protocols now may not save you from the current investigation, it may protect you from fraud in the future.

Conduct an Investigation

You’ll want to conduct your own investigation. If the government will be going through your business in excruciating detail, be ready to put in the same amount of work. If you are being investigated, you have a certain degree of responsibility and ownership at your office—you should be involved enough to know what may have led to your current legal troubles. If you take a hands-off approach or realize that you don’t even know where to begin with your business files, that may be a sign that something needs to change moving forward.

Contact a Healthcare Fraud Attorney

Do not wait to talk to a healthcare fraud attorney. An attorney with experience in Medicare, Medicaid, and Medi-Cal will know what you’re up against and different defense options to explore. The OIG is an incredibly well-funded agency with seemingly bottomless pockets when it comes to its investigations, and you cannot take them on alone. Your attorney may argue to limit the scope of the OIG’s investigation, determine what you are being investigated for, explore potential safe harbor provisions, and negotiating with the OIG when necessary.

Contact the Law Offices of Robin D. Perry to Learn More

When you’re the focus of an OIG investigation, your entire career is at stake—and your freedom and financial stability could also be under fire. Do not wait a moment longer to get the healthcare fraud defense you need. Call the Law Offices of Robin D. Perry at 562-216-2944 or send us a message online to schedule a consultation.

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