There are numerous reasons why healthcare providers might be investigated by state or federal law enforcement officials, mainly due to the numerous and stringent regulations in place to ensure proper healthcare practices are followed. Such activities that may be investigated include human resource violations, controlled substance issues, health insurance fraud, and general malpractice. There are also a whole host of agencies that might start an investigation, like the Department of Justice, the FBI, the DEA, the Department of Health, the District Attorney, or the Attorney General, to name a few. There are also several regulating agencies that conduct non-criminal investigations into healthcare providers in order to help maintain integrity and the safety of all those involved. It is possible that a certain provider might be investigated by multiple agencies working in tandem. Regardless of the circumstance, these investigations usually end negatively for the provider in question.

Investigation Triggers

Healthcare fraud is hard to keep covered for long. Random audits often shed light on any shady activities, and scheduled audits reveal even more. Outside complaints can often trigger an investigation, at least preliminarily. These complaints might come from a patient or a competitor, but if the information is credible, it will be investigated. It isn’t uncommon for the government to take advantage of informants and undercover operatives to conduct fully comprehensive investigations. Other investigation methods involve obtaining search warrants and subpoenas to gain access to restricted or confidential information that may hide the truth of a healthcare provider’s actions. Surveillance equipment is also used to collect any relevant evidence for the case.

Provider Response

Healthcare providers must be vigilant when it comes to these investigations. It is vital that the provider learn as much as possible about how the investigating agency operates. These companies shouldn’t attempt to deal with investigations on their own, even if they are convinced of their own innocence. Healthcare providers have rights just like any other entity, and it is best to protect those rights with the help of a dedicated law firm. Only those with the proper experience can adequately handle an investigation from a government agency.

One of the first things a healthcare criminal defense lawyer will tell a healthcare provider under investigation is that they should be prepared for the possibility of evidence-sharing between government agencies. Every interaction that the provider has with the investigating agency could be used against them in court, regardless of the informality of the conversation. It is highly recommended that healthcare providers only speak with an investigating agency while their lawyer is present.

Government investigations into healthcare providers is common enough that every provider should develop a set of protocols for dealing with them. One of the most basic protocols a provider can establish is a contact person who will be the dedicated line of communication between the investigating agency and the provider’s lawyer. If anyone other than the contact person is questioned by an agent, they should refer the agent to the contact person, who will then contact the attorney. This will prevent any accidentally incriminating statements from being made to the investigating agency.

Document Retention

A criminal defense attorney representing a healthcare provider during a government investigation will also provide valuable details during the investigation. The government will often demand certain pieces of evidence directly from the healthcare provider, namely financial or institutional records, testimony from staff members, and any other sources they think are viable. There are instances when a healthcare provider might face harsher penalties as a result of their failure to produce certain pieces of evidence for the investigators, and there are also times when the investigating agency might demand something which they have no right to demand. Without a criminal defense attorney, it can be difficult for healthcare providers to know which actions to take when pressed for evidence.

Many healthcare providers make the mistake of blindingly handing over every bit of information they can in the hopes of prompting the investigators to see it as a sign of transparency and thus innocence. This is strongly advised against by criminal defense attorneys. A provider might accidentally hand the investigators everything they need to make an allegation stick since investigators aren’t usually prone to leniency. Of course, when a provider fails to produce required documentation or evidence, it can force additional charges to be levied against them. Only an experienced criminal defense lawyer can adequately state what should be done in specific scenarios where evidence is requested.

After the Investigation

Criminal charges will only be filed after an investigation has come to a close. Sufficient evidence must be uncovered in order for that to happen, but it could lead to any number of outcomes, including heavy fines and possibly even jail time. The earlier a provider can retain the services of a dedicated criminal defense attorney, the more likely they are to receive the optimal results. The provider should disclose all pieces of relevant info to their defense attorney so they can give the best advice for the situation.

In some instances, the healthcare provider will be offered a settlement, but those settlements aren’t always the best course of action. A criminal defense attorney can determine if a settlement offer is worth the cost, which usually involves pleading guilty to a charge of less severity than the actual crime committed. It is vital for healthcare providers to take advantage of the services of a criminal defense lawyer during a government investigation.