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What to Do if You’re Being Investigated for Healthcare Billing Fraud

What to Do if You’re Being Investigated for Healthcare Billing Fraud

So you got a letter saying your being looked at for possible healthcare billing fraud. That really sucks. I know your probably freaking out wondering what happens next. Take a deep breath. This don’t necessarily mean your guilty of anything. Lots of investigations end with no charges filed. This article will walk you through how to handle a fraud investigation the right way.

Understanding Healthcare Billing Fraud

First up – what exactly is healthcare billing fraud? It’s when someone intentionally lies or misleads to get more money from Medicare, Medicaid, or private health plans. Some examples include:

  • Billing for services that weren’t provided
  • Billing for more expensive services than actually done
  • Using a patient’s info to bill for services for someone else
  • Billing multiple payers for the same service

Most docs and medical providers follow the rules. But fraud still happens. And when caught, you may face criminal charges or civil lawsuits to recover money.

Who Investigates Healthcare Fraud

Several agencies can investigate fraud allegations like:

  • DOJ – Runs Medicare Fraud Strike Forces with FBI, investigates criminal cases.
  • OIG – Inspector General’s office investigates Medicare fraud.
  • State Medicaid Fraud Control Units – Investigate Medicaid fraud for states.
  • Private insurers – Have their own fraud investigation units.

These investigators have power to subpoena records, interview witnesses, get search warrants, and make arrests.

If You Get a Subpoena

A subpoena means they want records from you. Don’t ignore it – that can lead to obstruction charges. Hire a lawyer immediately to help respond. They’ll ensure you meet the deadline and protect any privileged info.

Gather the records requested and provide to your attorney to review and turn over. Don’t alter or destroy any subpoenaed records – that’s illegal.

Christine Twomey
Christine Twomey
2024-03-21
Just had my Divorce case settled 2 months ago after having a horrible experience with another firm. I couldn’t be happier with Claire Banks and Elizabeth Garvey with their outstanding professionalism in doing so with Spodek Law Group. Any time I needed questions answered they were always prompt in doing so with all my uncertainties after 30 yrs of marriage.I feel from the bottom of my heart you will NOT be disappointed with either one. Thanks a million.
Brendan huisman
Brendan huisman
2024-03-18
Alex Zhik contacted me almost immediately when I reached out to Spodek for a consultation and was able to effectively communicate the path forward/consequences of my legal issue. I immediately agreed to hire Alex for his services and did not regret my choice. He was able to cover my case in court (with 1 day notice) and not only was he able to push my case down, he carefully negotiated a dismissal of the charge altogether. I highly recommend Spodek, and more specifically, Alex Zhik for all of your legal issues. Thanks guys!
Guerline Menard
Guerline Menard
2024-03-18
Thanks again Spodek law firm, particularly Esq Claire Banks who stood right there with us up to the finish line. Attached photos taken right outside of the court building and the smile on our faces represented victory, a breath of fresh air and satisfaction. We are very happy that this is over and we can move on with our lives. Thanks Spodek law 🙏🏼🙏🏼🙏🏼🙏🏼🙌🏼❤️
Keisha Parris
Keisha Parris
2024-03-15
Believe every single review here about Alex Z!! From our initial consultation, it was evident that Alex possessed a profound understanding of criminal law and a fierce dedication to his clients rights. Throughout the entirety of my case, Alex exhibited unparalleled professionalism and unwavering commitment. What sets Alex apart is not only his legal expertise but also his genuine compassion for his clients. He took the time to thoroughly explain my case, alleviating any concerns I had along the way. His exact words were “I’m not worried about it”. His unwavering support and guidance were invaluable throughout the entire process. I am immensely grateful for Alex's exceptional legal representation and wholeheartedly recommend his services to anyone in need of a skilled criminal defense attorney. Alex Z is not just a lawyer; he is a beacon of hope for those navigating the complexities of the legal system. If you find yourself in need of a dedicated and competent legal advocate, look no further than Alex Z.
Taïko Beauty
Taïko Beauty
2024-03-15
I don’t know where to start, I can write a novel about this firm, but one thing I will say is that having my best interest was their main priority since the beginning of my case which was back in Winter 2019. Miss Claire Banks, one of the best Attorneys in the firm represented me very well and was very professional, respectful, and truthful. Not once did she leave me in the dark, in fact she presented all options and routes that could possibly be considered for my case and she reinsured me that no matter what I decided to do, her and the team will have my back and that’s exactly what happened. Not only will I be liberated from this case, also, I will enjoy my freedom and continue to be a mother to my first born son and will have no restrictions with accomplishing my goals in life. Now that’s what I call victory!! I thank the Lord, My mother, Claire, and the Spodek team for standing by me and fighting with me. Words can’t describe how grateful I am to have the opportunity to work with this team. I’m very satisfied, very pleased with their performance, their hard work, and their diligence. Thank you team!
Anthony Williams
Anthony Williams
2024-03-12
Hey, how you guys doing? Good afternoon my name is Anthony Williams I just want to give a great shout out to the team of. Spodek law group. It is such a honor to use them and to use their assistance through this whole case from start to finish. They did everything that they said they was gonna do and if it ever comes down to it, if I ever have to use them again, hands-down they will be the first law office at the top of my list, thank you guys so much. It was a pleasure having you guys by my side so if you guys ever need them, do not hesitate to pick up the phone and give them a call.
Loveth Okpedo
Loveth Okpedo
2024-03-12
Very professional, very transparent, over all a great experience
Bee L
Bee L
2024-02-28
Amazing experience with Spodek! Very professional lawyers who take your case seriously. They treated me with respect, were always available, and answered any and all questions. They were able to help me very successfully and removed a huge stress. Highly recommend.
divesh patel
divesh patel
2024-02-24
I can't recommend Alex Zhik and Spodek Law Firm highly enough for their exceptional legal representation and personal mentorship. From the moment I engaged their services in October 2022, Alex took the time to understand my case thoroughly and provided guidance every step of the way. Alex's dedication to my case went above and beyond my expectations. His expertise, attention to detail, and commitment to achieving the best possible outcome were evident throughout the entire process. He took the time to mentor me, ensuring I understood the legal complexities involved to make informed decisions. Alex is the kind of guy you would want to have a beer with and has made a meaningful impact on me. I also want to acknowledge Todd Spodek, the leader of the firm, who played a crucial role in my case. His leadership and support bolstered the efforts of Alex, and his involvement highlighted the firm's commitment to excellence. Thanks to Alex Zhik and Todd Spodek, I achieved the outcome I desired, and I am incredibly grateful for their professionalism, expertise, and genuine care. If you're in need of legal representation, look no further than this outstanding team.

If Investigators Want to Interview You

Investigators may ask to interview you as part of the probe. Politely decline and refer them to your lawyer. NEVER speak without your attorney present – anything you say can be used against you.

Your lawyer will prepare you for the interview and attend to make sure your rights are protected.

Building Your Defense

While the investigation unfolds, start building your defense in case charges come. Gather records like:

  • Medical records backing up services billed
  • Timesheets and schedules proving you were working
  • Emails and documents refuting allegations
  • Records of compliance training

Basically gather anything showing you billed properly. Also write a timeline from your view. Your attorney can compare it to the investigators’ timeline.

If Charges Are Filed

If formal fraud charges get filed, your lawyer will walk you through the process and build a defense strategy. This may include:

  • Seeking dismissal of defective charges
  • Negotiating a plea bargain
  • Going to trial

Don’t lose hope – charges sometimes get dismissed pre-trial. And even if convicted, your lawyer can argue for leniency.

Cooperating with Investigators

Your lawyer may advise cooperating with the investigation, like through a proffer session. This involves sitting down with investigators informally and sharing what you know. Statements you make can’t be used directly against you.

Cooperation can lead to lesser charges or even immunity. But run it by your attorney first – don’t go it alone.

Avoiding Retaliation

It’s illegal for anyone to retaliate against you for cooperating with investigators. Report any harassment, discrimination, or other retaliation to your lawyer immediately.

Takeaways if Facing an Investigation

Here’s a quick summary of what to do if your under investigation for healthcare billing fraud:

  • Get a lawyer immediately
  • Don’t ignore subpoenas
  • Don’t talk to investigators without your lawyer
  • Gather evidence of your innocence
  • Consider cooperating through your attorney
  • Report any retaliation

And stay positive! Many probes end with no action taken. But if charges come, fight them with your lawyer’s help. Don’t go through it alone.

 

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