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Healthcare Fraud; Medicaid and Medicare Practices

"The Attorney General’s Office, Medicaid Fraud Control Unit (“MFCU”), entered our medical office and took a bunch of data and files from my medical practice, what should I do?"

The Medicaid Fraud Control Unit is an office of the Georgia Office of the Attorney General that investigates and prosecutes doctors and other medical practitioners, including chiropractors and dentists, for double billing, over billing, “upcoding” bills, payment of kickbacks to equipment suppliers (including “DME” – durable medical equipment), and criminal neglect and abuse in nursing homes. They also often work in conjunction with the Office of Health and Human Services (“HHS”) to investigate improper payments on the federal level.

These investigative agencies work with law enforcement, nurses, and analysts to seize and review medical records for evidence of bribes, kickbacks, and other improper payments to or from medical providers. If your practice has received a document request from any enforcement authority then you need retain counsel who has extensive experience in subpoena compliance, as well as health care fraud defense. Healthcare fraud is the fastest growing focus area for state and federal law enforcement. The current law enforcement objective is to target medical practitioners, seize the assets of the practice, and imprison the physician on wire fraud or conspiracy charges. Gone are the days when practitioners can cut a check and return to their practices.

The healthcare fraud investigators typically take their initial “tips” from disgruntled former employees, who serve as whistleblowers for alleged misconduct. This means that the healthcare fraud team will have a good idea about the details of your practice and the current and former employees who might provide useful information to law enforcement in the matter. Because the investigators will likely have this information, it is imperative to promptly retain experienced and competent counsel – in order to minimize any criminal exposure that may arise. The investigators will be interviewing these current and former employees in conjunction with conducting their document review. Experienced counsel retained on behalf of the healthcare provider will be reaching out to those same employees – to see who has given statements and to determine the real areas of inquiry for the investigation.

Medical practices that do substantial billing to Medicaid or Medicare should be particularly concerned about coding practices, misuse of the coding systems by employees, and the potential that “rogue employees” have been committing Medicaid fraud and then pocketing those illicit proceeds. Oftentimes, evidence develops that the billing system is misused by employees who are put in positions of trust and responsibility. If the coding employees are implicated in a billing investigation, then the physicians who supervised them will, out of necessity, need counsel to protect their interests in the ongoing investigation.

If your practice is under investigation, feel free to reach out to us at 404.713.3283 or click HERE to discuss your situation and see if we can help. We are located in the Battery area of Atlanta and have over 30 years of experience in healthcare fraud and related white collar defense work.

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