Practice Areas
Audits and investigations of health care practices have dramatically increased over the past ten years. These come from many sources including Medicare, MediCal, TriCare, and the OWCP on a federal level, and the Division of Insurance, Attorney General, District Attorney, and the DWC on a state level. In addition, private insurance carriers have started fraud and special investigation units as well as provider audit units.
Audits
Even what appears initially as a harmless request for records can turn into a request for repayment of thousands, hundreds of thousands, or millions of dollars. Proper representation from the beginning is helpful, and at the middle and later stages, critical.
Investigations
The most common way a doctor learns that an investigation has begun is when the investigator shows up at the doctors’ office, unannounced. Hoping to catch the doctor by surprise, the investigator may be kind, friendly, and accommodating, particularly as long as the doctor is cooperative and answering their questions. The problem is that the doctor is typically not prepared to answer such questions, and may not even know what the investigation is about when it first begins. Answers may be haphazard, incomplete, and misdirected. In certain cases, the doctor may be better off to simply not answer an investigator’s questions. But knowing what to do and what not to do is critical. For this reason, we recommend that counsel be engaged right away, from the very start of an investigation. This allows the attorney to most effectively represent and protect the doctor and his or her practice.
As the investigation proceeds, the involvement of experienced counsel becomes even more important. With investigations presenting the possibility of civil and criminal charges, the doctor should be very careful in selecting the right lawyer for the job.
Audits & Investigations
Practice Areas
Audits and investigations of health care practices have dramatically increased over the past ten years. These come from many sources including Medicare, MediCal, TriCare, and the OWCP on a federal level, and the Division of Insurance, Attorney General, District Attorney, and the DWC on a state level. In addition, private insurance carriers have started fraud and special investigation units as well as provider audit units.
Audits
Even what appears initially as a harmless request for records can turn into a request for repayment of thousands, hundreds of thousands, or millions of dollars. Proper representation from the beginning is helpful, and at the middle and later stages, critical.
Investigations
The most common way a doctor learns that an investigation has begun is when the investigator shows up at the doctors’ office, unannounced. Hoping to catch the doctor by surprise, the investigator may be kind, friendly, and accommodating, particularly as long as the doctor is cooperative and answering their questions. The problem is that the doctor is typically not prepared to answer such questions, and may not even know what the investigation is about when it first begins. Answers may be haphazard, incomplete, and misdirected. In certain cases, the doctor may be better off to simply not answer an investigator’s questions. But knowing what to do and what not to do is critical. For this reason, we recommend that counsel be engaged right away, from the very start of an investigation. This allows the attorney to most effectively represent and protect the doctor and his or her practice.
As the investigation proceeds, the involvement of experienced counsel becomes even more important. With investigations presenting the possibility of civil and criminal charges, the doctor should be very careful in selecting the right lawyer for the job.