Last Updated on: 28th July 2023, 07:23 pm

What To Do When HHS or OIG Agents Arrive Unannounced: A Detailed Guide

Seeing federal agents suddenly appear at your home or business, flashing badges and asking questions, is jarring for anyone. For physicians, healthcare executives, and other medical professionals, investigations by HHS and the Office of Inspector General (OIG) invoke especial dread given their power over licenses, reimbursements, and exclusion authorities.

When faced with this surprise predicament, having a plan is crucial to protecting your rights without creating bigger issues. This guide covers:

• How HHS and OIG conduct investigations
• Understanding reasons agents may want to interview you
• What to do when agents first arrive at your door
• Interacting with agents if you consent to an interview
• Tactfully refusing an immediate interview
• Finding an experienced attorney to advocate for you

With some preparation and prudence, you can respond properly to limit exposure while avoiding obstruction charges. Don’t let shock and panic lead to rash choices.

How HHS/OIG Conduct Fraud and Abuse Investigations

As watchdogs over federal healthcare programs, HHS and OIG employ over 500 investigators empowered to probe suspected:

• Medicare/Medicaid fraud schemes
• Stark/Anti-Kickback violations
• Opioid prescribing abuses
• Fraudulent billings
• Off-label marketing
• Falsified reimbursement claims

Their arsenal includes surveilling suspects, issuing subpoenas, analyzing medical records, interviewing witnesses, and coordinating with other agencies. Charges can lead to prison time and exclusion from healthcare programs.

Understanding the motivations and methods of investigators allows you to respond appropriately to their inquiries rather than make matters worse.

Why Agents May Show Up Requesting an Interview

Motivations for federal agents arrive unannounced at your home, office or other location seeking to ask you questions include:

• Trying to elicit an admission of wrongdoing or incriminating statements from you
• Seeking background information to bolster a larger case against others
• Wanting you as a witness against a primary target of their investigation
• Trying to recover documents or data you may possess
• Testing your willingness to cooperate with their investigation
• Gathering evidence to charge you with obstruction if you refuse to cooperate

Understanding why agents want to interview you shapes your response strategy. Proceed with caution no matter their stated agenda.

What To Do When Federal Agents First Arrive

The key when HHS/OIG agents first appear at your doorstep is to not panic. Politely ask to see their credentials and record any proffered badge/ID numbers. Do not let them in yet. Tell them you need a moment to prepare and will return shortly.

During this brief pause:

• Ask them to wait outside while you make a phone call.
• If they have a warrant, ask for a copy to review before allowing entry.
• Call an attorney to urgently ask for guidance.
• If no attorney reachable, prepare yourself mentally for the interaction.
• Ask the agents to return later if no exigent safety reasons exist for immediate entry.

This allows you to gather your wits, understand your rights, and protect yourself. Do not answer questions on the spot or invite them in without advice of counsel.

How To Interact If You Consent to an Interview

While usually advisable to delay interviews for counsel, you may decide answering a few limited questions is in your best interest if you have done nothing wrong. If so:

• Ask the agents to explain why they want to speak with you and if you are a target.
• Request that the conversation be recorded so there is a record of what is said.
• Answer questions transparently BUT only provide information directly responsive to the exact question asked.
• Do not volunteer tangential facts hoping to be helpful.
• If you do not know or cannot recall an answer, say so rather than guessing.
• Avoid offering opinions or exaggerating details.
• Decline any request to sign a document without attorney review.

The more you say, the more likely that a statement gets misconstrued or used against someone. Tread cautiously.

How To Tactfully Refuse an Immediate Interview

Typically, acceding to an on-the-spot interview is inadvisable since federal agents are skilled at eliciting damaging information from nervous suspects. It is fully within your rights to politely defer as follows:

• “Thank you, but I will not be answering any substantive questions without my attorney present.”
• “Respectfully, I am unable to consent to an interview today. Please feel free to reach out to my lawyer to arrange something.”
• “With all due respect, I cannot provide any information until I consult with my counsel.”

Stay calm and collected. Do not argue with agents, attempt to flee, or destroy evidence. Simply decline to provide substantive information.

Make it clear you intend to cooperate through proper legal channels at a later time. Have counsel contact them promptly to discuss next steps.

Finding an Experienced Attorney to Advocate for You

The moment federal investigators appear, you need authoritative guidance from a lawyer well-versed in navigating government health fraud inquiries. Look for someone with specific expertise handling HHS OIG matters.

Qualities to seek in the right legal advocate include deep knowledge of:

• Healthcare compliance requirements
• Fraud laws like Stark, Anti-Kickback, False Claims Act
• Sentencing guidelines and exclusions
• Mitigating audits and overpayments
• Negotiating settlements
• Avoiding obstruction charges

Having the right attorney intervene quickly can mean the difference between charges and closure. Vet any candidate thoroughly based on qualifications and past outcomes.

Work Closely with Counsel to Resolve the Investigation

Receiving a visit from federal agents is jolting, but not necessarily indicative of wrongdoing. By keeping calm, refusing to answer substantive questions without counsel, and allowing your attorney to interface with investigators directly, you maximize the chances of a favorable outcome.

Whether you become a cooperating witness, supply explanatory records, agree to enhanced compliance terms, or simply assert your innocence, have an experienced attorney quarterback your side’s response.

Do not go it alone and trust investigators to be impartial. Protect yourself against self-incrimination but also obstruction charges. Let your lawyer handle the nuances while you focus on your work and family. With prudence and prep, even surprise investigations can conclude favorably.