How to handle a Medicare fraud investigation

As a medical professional, you are committed to providing your patients the best possible care. Part of your care includes filing necessary paperwork with insurance companies and Medicare. Unfortunately, paperwork errors sometimes occur. With the federal government trying to crack down on Medicare fraud, you may find yourself facing charges because of an unintended mistake.

You do not have to let an accusation of misconduct ruin your career.

Medicare fraud charges could include accusations of billing for services not provided, overcharging for services, billing twice for the same service, providing unneeded care or submitting untrue cost reports. If accused, you could face charges from the US Department of Health and Human Services or the FBI.

You could receive a letter in the mail

An investigator may send you a letter in the mail. The letter may state that you are being audited and ask for documentation. Likely, the letter will reference certain cases you treated. How you respond, and what documentation you include as part of your response, could be very impactful. You may want to consider hiring an attorney who handles heath care fraud cases to help you with responding and answer questions you have about the letter and the requests it contains.

Investigator may request an interview

The investigator may also request an interview with you or your employees. At this point, the investigator has likely put together documentation that might support a Medicare fraud charge. During an interview, the investigator may be hoping you will say something that supports that charge. Having an attorney present could help protect you and your practice.

Conviction on Medicare fraud charges could include criminal penalties, being unable to serve Medicare patients, fines or even sanctions against your practice, which could result in the loss of your license. A Medicare fraud conviction could also damage your reputation in the community.

You will want to protect your reputation and your practice from allegations of fraud. Contacting an attorney may be in your best interest.