17 Oct 23

How Lawyers Protect Physicians During Healthcare Fraud Investigations

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Last Updated on: 26th October 2023, 10:31 pm

How Lawyers Protect Physicians During Healthcare Fraud Investigations

For physicians, being targeted in a federal healthcare fraud investigation can destroy careers and livelihoods, even if no charges ultimately result. Skilled defense attorneys use various strategies to protect physicians’ interests throughout these complex investigations.

Shielding the Medical License

One of the first things attorneys do is negotiate with investigators and licensing boards to prevent summary suspension of a physician’s license. They argue suspension would presume guilt prematurely and urge regulators to avoid taking action until the investigation concludes.

Preventing Program Exclusion

Lawyers also seek to prevent investigators from excluding physicians from Medicare, Medicaid and other federal healthcare programs during investigations. Exclusion can effectively end medical careers, so attorneys aggressively avoid this.

Challenging Hospital Privilege Revocation

If a hospital moves to revoke a physician’s practice privileges based on the investigation, counsel fights this through hearings and negotiations. Keeping privileges intact is critical.

Disputing Recoupment Efforts

When auditors initiate recoupment of prior reimbursements, lawyers dispute these efforts. They argue recoupment assumes improper billing not yet proven through the legal process.

Avoiding Reputational Harm

Attorneys work to prevent investigators from making inflammatory public statements. They also caution clients about avoiding comments that could damage reputations.

Gathering Exculpatory Evidence

Lawyers proactively gather records, data, peer input and other evidence to contradict allegations of improper practices and demonstrate the physician’s good faith.

Educating Investigators

Counsel meets with investigators to provide context around complex medical conditions, billing rules and records. The goal is correcting misimpressions about standard practices.

Coordinating Key Messaging

Attorneys advise physicians on communicating with colleagues, patients and the public about the investigation. The aim is maintaining trust and calm.

Negotiating Confidential Resolutions

Lawyers leverage their prosecutorial experience to negotiate settlements that resolve investigations confidentially whenever possible.

Navigating Parallel Proceedings

Counsel coordinates defense strategies across related license reviews, malpractice cases and other proceedings sparked by investigations.

Case Study Example

Here is a hypothetical scenario demonstrating how a skilled attorney protects a doctor facing fraud allegations:

The Scenario

Dr. Steven Jones, a cardiologist, is notified he is being investigated for allegedly overbilling Medicare for cardiac procedures. Dr. Jones stands to lose his medical license, hospital privileges and practice.

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Protection Strategy

Dr. Jones retains an experienced healthcare fraud defense attorney who takes the following actions:

  • Persuades the medical board not to suspend Dr. Jones’s license by arguing it would unfairly presume guilt
  • Disputes the hospital’s move to revoke privileges based on unproven allegations
  • Gathers data on outcomes demonstrating procedures were medically necessary
  • Meets with investigators to provide context on billing rules and records
  • Negotiates an agreement with the U.S. Attorney’s Office to resolve the case confidentially

The Outcome

Thanks to counsel’s efforts, Dr. Jones avoids loss of licensure and privileges. His practice continues uninterrupted despite the investigation.

An Ounce of Prevention

For physicians, charges don’t have to be filed for fraud investigations to destroy careers. Experienced counsel works aggressively to protect physicians on all fronts from the earliest stages.