Health care providers face official scrutiny as never before.
At the federal level, the Department of Justice (DOJ) and the various United States attorneys are responsible for most criminal investigations of suspected health care fraud. DOJ and the HHS Office of Inspector General (OIG) coordinate most civil investigations. At the state level, the various Attorneys General pursue investigations and criminal and civil sanctions for violations pertaining to the Medicaid program.
Criminal convictions carry the risk of substantial imprisonment, fines and administrative monetary sanctions; loss of professional licensure and controlled substance prescriber registration; and exclusion from participation in federal, state and private insurance programs. Civil investigations can entail enormous financial burden and also pose the risk of substantial monetary sanctions. A civil or criminal investigation can threaten the professional viability of the targeted individual or entity.
Investigations may be prompted by current and former employees, competitors, RAC and other payer audits, qui tam relator complaints under the False Claims Act, employment litigation, and press and trade accounts. Once a provider learns that an investigation is underway, a serious, coordinated response can mean the difference between a favorable and a disastrous outcome.
Ice Miller has a team of lawyers who focus on representing heath care providers in government investigations, criminal actions and civil lawsuits. Our team includes trial lawyers and former federal and state prosecutors who regularly represent health care providers in court and before government agencies. We represent clients in:
False Claims Act investigations and lawsuits, including qui tam and whistleblower actions
Government investigations, including fraud and abuse investigations by the FBI, OIG and state Medicaid fraud control units
Criminal actions, including grand jury investigations, search warrants, trials and appeals
Civil litigation involving medical staff disputes, employment matters, contract disputes, product liability cases, quality assurance and utilization review matters and EMTALA disputes and risk management
Administrative actions before licensing boards and other government agencies
Outside the investigative setting, we advise clients on compliance issues before they ripen into an investigation. We understand the voluntary disclosure process and conduct compliance reviews to determine whether a disclosure is necessary and in our client's