If a practitioner performs a particular procedure at a rate that greatly exceeds the prevailing norm in the industry then he can expect that it will draw the attention of the auditors, and at some point, perhaps law enforcement. 

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Likewise, if a medical practitioner’s office codes procedures in a way that attracts the attention of auditors (or whistleblowers) then they should expect that an investigation will ensue.

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The DOJ, HHS, FBI, and the MFCU Unit expend ever-increasing resources investigating medical practitioners for accounting irregularities and “up-coding,” the process where medical billing systems are charged additional fees for routine services.  The Dillon Law Group has extensive experience in representing health care professionals and health care practices in both civil and criminal investigations.  We routinely defend clients where the Government alleges that there has been over billing, up-coding of procedures, charges to governmental agencies for patients that were not provided services, billing for durable medical equipment that has not been provided, payment of kickbacks in the provision of services, fraudulent pharmaceutical practices, over prescribing, Stark Act violations, and prescription drug abuse.  The Government will not hesitate to pursue physicians and other medical practitioners if it feels fraud has been committed.

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If your medical practice has been implicated in a state or federal fraud investigation then you need experienced and aggressive representation.  If the Government has decided that you or your practice has violated the rule of law, they will use every tool at their disposal to examine every file and every aspect of your practice – going back for a decade, if they feel it is necessary.

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With a former federal prosecutor with decades of experience in these cases, the Dillon Law Group can anticipate the strategy that the Government will use to try to make its case.  We protect the interests of our clients, whether they are pharmacists, medical practitioners, chiropractors, pharmaceutical sales reps, or medical billing personnel.  We have had substantial success convincing the Government that prosecution is inappropriate in “gray areas” where a particular practice may not justify criminal sanction.  In these gray areas, we work closely with our clients, and relevant experts, to convince the Government that the particular practice is not a violation and that fraudulent intent is not evident. The Dillon Law Group has extensive experience conducting internal investigations in healthcare matters to defend our client’s interests.  Our objective is to minimize the client’s exposure and to resolve the matter in a way that comports with the client’s best strategic interest.