Key Strategies for Responding to Healthcare Fraud Investigations in California

Healthcare providers in California face stringent regulations aimed at preventing fraud and abuse within the healthcare system. When providers are targeted in a healthcare fraud investigation, the legal and financial consequences can be severe. Common allegations may include billing fraud, kickback violations, upcoding, and violations of the False Claims Act. If you are a healthcare provider facing such an investigation, it is crucial to respond strategically to protect your practice and your professional reputation.

Below we discuss key strategies to help healthcare providers effectively navigate healthcare fraud investigations in California. For personalized assistance from an experienced California healthcare fraud defense attorney, contact the Law Offices of Art Kalantar located in Beverly Hills.

1. Engage Experienced Legal Counsel Immediately

One of the first and most critical steps in responding to a healthcare fraud investigation is securing representation from an experienced healthcare law attorney. The legal landscape surrounding healthcare fraud is complex, and you need a lawyer with specialized knowledge of both state and federal healthcare laws. An experienced attorney can help you understand the scope of the investigation, the potential legal exposure, and the most effective defense strategies.

Your attorney will likely advise against communicating directly with investigators without legal representation. Any statements made during an investigation can be used against you, and a skilled lawyer will ensure that your rights are protected throughout the process.

2. Conduct an Internal Audit and Risk Assessment

As soon as you become aware of an investigation, it is important to conduct a thorough internal audit of your billing practices, patient records, and compliance with relevant laws. This will help you identify any potential issues that may have triggered the investigation. An internal review also enables you to prepare for potential weaknesses in your case and develop a strong defense.

Your attorney may bring in healthcare compliance experts to assist in the audit. These professionals can help identify unintentional errors or areas of non-compliance that can be corrected. In some cases, voluntary disclosure of errors may be advisable, as it can show good faith efforts toward compliance.

3. Preserve All Relevant Documentation

During an investigation, you may be asked to provide documentation, including patient records, billing statements, and internal communications. It is critical to preserve all relevant documents and avoid any actions that could be interpreted as tampering with or destroying evidence. Failure to maintain proper documentation could lead to additional legal consequences, including obstruction of justice charges.

A document preservation plan should be implemented as soon as an investigation is initiated, ensuring that no documents are lost, deleted, or otherwise altered.

4. Maintain Compliance with Government Requests

Healthcare fraud investigations often involve subpoenas, search warrants, or document requests from government agencies such as the California Department of Justice or the Office of Inspector General (OIG). It is essential to comply with these requests promptly and accurately. However, it is equally important that you do not provide more information than is requested, as over-disclosure could complicate your defense.

Your attorney will guide you through the process of responding to these requests, ensuring compliance while protecting your legal interests. If a search warrant is executed, it is crucial to cooperate with authorities but also to contact your attorney immediately.

5. Grand Jury Subpoenas, Administrative Subpoenas and Civil Investigative Demands

There are different investigative tools that government special agents and/or investigators use to obtain information from your healthcare business.

Oftentimes, in a criminal investigation, the investigators and/or special agents will serve a Grand Jury Subpoena, and in a civil investigation, will serve a Civil Investigative Demand (CID). In another type of investigation, an individual or company will be served with an Administrative Subpoena.

When one is served with either type of subpoena, or CID, the person’s or company’s rights, responsibilities and defenses can vary significantly. It is critical to consult with an experienced attorney who can help to develop a strategy to properly protect all rights.

6. Avoid Discussing the Investigation With Staff or Colleagues

While it may be tempting to discuss the investigation with staff or colleagues, doing so could lead to misunderstandings or inadvertent disclosures of sensitive information. In some circumstances, it could result in the loss of attorney-client privilege. Staff members may be interviewed as part of the investigation, and any statements they make could be used against you. It is important to limit discussions about the investigation and to advise your staff to cooperate fully with your legal team.

Your attorney can help you develop a communication plan to ensure that everyone involved understands their roles and responsibilities during the investigation.

7. Proactively Address Compliance Gaps

If your internal audit reveals compliance gaps or issues in your billing practices, taking proactive steps to address these issues can be crucial. Implementing corrective measures, such as enhanced training for staff, updating billing protocols, and improving compliance oversight, can demonstrate your commitment to ethical practices. These efforts may mitigate the consequences of the investigation and could potentially lead to a more favorable outcome.

In some cases, self-disclosure of minor errors may be an effective strategy, especially when combined with evidence of corrective actions. However, this approach should only be undertaken after consulting with your attorney, as it may not be appropriate in every situation.

8. Prepare for Civil and Criminal Penalties

Healthcare fraud investigations can lead to both civil and criminal penalties, depending on the severity of the alleged violations. Providers may face civil fines, exclusion from Medicare and Medicaid programs, or even criminal charges that carry prison sentences. Understanding the potential consequences is important for developing a defense strategy.

Your attorney will help you evaluate the risks associated with your case and will work to negotiate with government agencies to reduce penalties where possible. In some cases, settlements may be reached to avoid lengthy litigation, but your legal team will always aim to protect your professional license and minimize the impact on your practice.

9. Stay Informed and Updated on Healthcare Regulations

Healthcare fraud investigations often arise from regulatory changes or new enforcement priorities. As a provider, it is essential to stay informed about both state and federal healthcare regulations. By staying up-to-date on legal requirements, you can reduce your risk of becoming the target of future investigations.

A proactive approach to compliance, including ongoing education and training for your staff, can help you maintain a strong defense against potential allegations of fraud.

Contact Attorney Art Kalantar for Strategic and Effective Healthcare Fraud Defense in California

Facing a healthcare fraud investigation in California can be stressful and intimidating, but with the right legal strategies, you can protect your rights and your practice. If you are a California healthcare provider under investigation for fraud, contact the Law Offices of Art Kalantar today at 310-773-0001. Our experienced legal team is dedicated to defending healthcare providers and ensuring that your rights are protected throughout the investigation process.