what should I do when hhs or oig agents show up at my door to interview me

As the sun sets on another day, you find yourself closing the door to your home after a long day at work. The familiar aroma of dinner cooking wafts through the air as you prepare to sit down with your loved ones and enjoy a meal together. But just as you’re about to take your first bite, an unexpected knock at the door disrupts the peacefulness of the evening. As you open the door, you are met with the sight of two federal agents, their badges bearing the insignia of the U.S. Department of Health and Human Services’ Office of Inspector General (HHS OIG). They have come with questions for you, and you can’t help but feel a sense of unease wash over you.

But what exactly is the HHS OIG, and what role do they play in federal law enforcement? The Office of Inspector General is the law enforcement division of the U.S. Department of Health and Human Services. Their mission is to combat waste, fraud, and abuse within all federal healthcare programs, with a specific focus on tackling Medicare and Medicaid fraud. As the largest inspector general’s office in the Federal Government, the HHS OIG has the resources and authority to extend its oversight to programs within other institutions within the HHS, such as the Centers for Disease Control and Prevention, National Institutes of Health, and the Food and Drug Administration.

To achieve this goal, the HHS OIG targets healthcare providers and entities that bill these programs for patient services, medical supplies, and durable medical equipment (DME). They investigate all types of intentional and unintentional billing violations, as prohibited by the applicable program billing regulations, the False Claims Act, the Anti-Kickback Statute, the Stark Law, and various other sources of federal authority. Common allegations in HHS OIG investigations include billing for services, supplies, or DME not actually provided (“phantom billing”), billing for medically-unnecessary services, supplies, or DME, supplying opioid medications to drug-dependent patients or without adequate evidence of medical necessity, submitting incorrect billing codes, double-billing Medicare, Medicaid, and/or a private healthcare insurance company, engaging in unlawful kickback or referral fee transactions, and participating in a conspiracy to overbill Medicare or Medicaid. With their relentless efforts to fight fraud and protect the integrity of these crucial programs, the HHS OIG is a formidable force in the ongoing battle against waste, fraud, and abuse within the healthcare system.

As the HHS OIG delves deeper into the complex web of Medicare and Medicaid billing data, they rely on a variety of investigative tactics to determine if a provider has overbilled these programs. An investigation may arise from an automated review of a provider’s billing data, an administrative audit, a tip from a patient or employee, or even from an investigation into another provider’s billing practices. Regardless of the origins, the ultimate goal of the investigation is to gather enough evidence for federal prosecutors to pursue civil or criminal charges. If the investigation yields sufficient evidence to establish probable cause, the HHS OIG may choose to pursue the case themselves, or collaborate with the U.S. Department of Justice to seek an indictment in federal district court.

In this scenario, let’s say you are being targeted in a case involving allegations under the federal Anti-Kickback Statute. The HHS OIG has been investigating a DME supplier, and as they dig deeper, your name comes up as one of the supplier’s customers. The supplier’s financial records indicate that you have received rebates that potentially qualify as unlawful “remuneration” under the Anti-Kickback Statute. Additionally, a review of your practice’s Medicare billing data shows that you have ordered a higher volume of DME than other providers in your geographic area. The HHS OIG is now at a critical juncture in their investigation. They know that your practice has an ongoing financial relationship with the DME supplier and they are prepared to pursue charges against the supplier for Anti-Kickback Statute violations. But the question remains, will they also pursue charges against you?

At this point, the HHS OIG is looking to you to provide an explanation as to why the perceived “rebates” do not violate the Anti-Kickback Statute in your particular case. If you are unable to provide a satisfactory explanation, they may also look to determine if you intentionally accepted unlawful rebates, which would make your case criminal in nature. With the stakes high and the HHS OIG’s extensive resources and authority, it is crucial that you understand the gravity of the situation and respond appropriately to their requests for interviews and information.

When the unexpected knock at the door reveals two federal agents, bearing the insignia of the U.S. Department of Health and Human Services’ Office of Inspector General (HHS OIG), it can be a nerve-wracking and overwhelming experience. The HHS OIG has the authority and resources to investigate allegations of fraud and abuse within federal healthcare programs, and their investigations can have serious consequences for those caught up in them. It is essential to understand the risks of voluntarily speaking to HHS OIG agents without the guidance of a lawyer.

From a self-protection standpoint, the difference between providing information voluntarily to the agents in an interview, and having a lawyer present to protect your rights, could not be more significant. In the first scenario, you may unknowingly give the agents reason to suspect that you have intentionally violated the law, or at the very least, acted with willful ignorance. In the second scenario, the agents leave without any additional information to use against you.

Furthermore, speaking to HHS OIG agents presents the risk of providing misleading information, which is a criminal offense under 18 U.S.C. § 1001, punishable by a fine and up to five years in prison. It’s also important to note that there is nothing that prohibits HHS OIG agents from lying to you. They may tell you that there is nothing wrong, that you have nothing to worry about, and that there is no reason for you to speak with an attorney. But if you fall for their tactics and say something that puts your practice or your freedom in jeopardy, then the agents will be able to testify as to the substance of your conversation and use your own words against you in court.

It’s crucial to understand the gravity of the situation and that the best way to protect yourself is to have a lawyer present during any interaction with the HHS OIG. With the stakes high and the complex nature of the law, speaking to an attorney before discussing the matter with the agents is an absolute must.