The term “healthcare fraud” conjures images of elaborate schemes and malicious intent. But in reality, many businesses find themselves ensnared in investigations due to unintentional errors, misinterpretations of complex regulations, or even overzealous enforcement. The consequences, however, are just as real: hefty fines, reputational damage, and potential exclusion from federal healthcare programs.
At SKT Law, we’ve stood by countless businesses facing the daunting specter of healthcare fraud investigations. Our team of seasoned attorneys, with their extensive experience and unwavering support, is committed to providing the expertise you need to safeguard your future. You can trust us to guide you through this challenging time.
Understanding the Accusations
Before you can effectively defend against allegations of healthcare fraud, it’s crucial to understand the specific claims against you. These allegations can stem from a variety of sources, including:
- Billing Errors: Accidental upcoding, unbundling, or billing for services not rendered can trigger investigations.
- Whistleblower Complaints: Current or former employees may report suspected fraudulent activity.
- Government Audits: Routine audits can uncover irregularities in billing practices or documentation.
- Data Analysis: Government agencies utilize sophisticated data analysis tools to identify potential fraud patterns.
The False Claims Act
The False Claims Act (FCA) is a powerful tool the government uses to prevent healthcare fraud. It allows individuals to file lawsuits on behalf of the government (known as qui tam lawsuits) and potentially receive a portion of any recovered damages. Understanding the FCA is crucial in building a defense strategy.
Protecting Your Business: Proactive Measures
While facing an investigation can be overwhelming, taking proactive steps can significantly strengthen your position:
Assemble a Legal Team:
Engage an experienced healthcare fraud defense attorney, like SKT Law, as soon as possible. They will guide you through the legal process, protect your rights, and develop a tailored defense strategy. Your legal team will also handle all communications with the investigating authorities, ensuring that you don’t inadvertently say something that could be used against you.
Internal Investigation:
Conduct a thorough internal review of your billing practices, documentation, and compliance procedures. For example, you might find that your staff needs more training on coding procedures, or that your documentation could be more comprehensive. Identify any potential vulnerabilities or areas for improvement.
Gather Evidence:
Preserve all relevant documents, including medical records, billing invoices, and communications with patients and insurance companies. This evidence can be crucial in refuting allegations.
Cooperation (with Caution):
Cooperate with investigators but do so under the guidance of your attorney. Avoid making statements that could be misinterpreted or used against you.
“Early intervention and a proactive approach are key in healthcare fraud investigations. The sooner you engage legal counsel and begin building your defense, the better your chances of a successful outcome.”
Eliot Krieger, CEO & Managing Partner, SKT Law
Building Your Defense
A strong white-collar criminal defense strategy involves more than just refuting allegations; it requires a comprehensive approach to protect your business and reputation:
Legal Arguments:
We will analyze the evidence against you, identify any legal weaknesses in the government’s case, and build a robust legal argument to challenge the allegations.
Negotiation and Settlement:
In some cases, negotiating a settlement with the government may be a viable option. This can often result in a reduction of penalties and a quicker resolution, saving you time and money. We can advocate on your behalf to ensure that any settlement is fair and in your best interests.
Litigation:
If necessary, we will defend your case in court, presenting evidence, cross-examining witnesses, and arguing for your innocence.
Related Article: Common Mistakes to Avoid in White-Collar Crime Investigations
Build A Defense Against Healthcare Fraud Allegations With SKT Law
The prospect of a healthcare fraud investigation can be daunting, but it doesn’t have to be the end of your business. By taking swift action, partnering with experienced legal counsel, and building a strong defense, you can protect your company, your reputation, and your future.
At SKT Law, we are committed to providing you with the expertise and support you need to overcome this challenging situation. Don’t face this alone. Contact SKT Law today for a confidential consultation.