Falsely Accused of Healthcare Fraud? Here’s what You Should Know

There are many reasons why someone may be targeted by false healthcare fraud accusations Whistleblowers may be motivated by a desire to fight fraud, waste, and abuse. They may also be incentivized by the fact that they receive a percentage of the recovered fraudulent payments.

Unfortunately, this results in some people making up allegations of fraud or choosing to interpret aggressive treatment as healthcare fraud. That you thought you were better serving your patients or face significant legal fees facing such charges doesn’t matter to them. That doesn’t mean that you can’t fight back, however. Here’s what you should know and do If you’ve been falsely accused of healthcare fraud.

Convene a Team Immediately

If you receive a subpoena or even hear of allegations that you’re guilty of Medicare fraud, the most important thing you can do is consult with a Medicare fraud attorney as soon as possible. Create a team that includes expert legal counsel. Don’t do anything without legal guidance. For example, you will hurt your case if you try to shred documents or delete files. Preserve all evidence, whether it is electronic or paper.

Perform an Internal Investigation

Working with your legal counsel, perform an internal investigation. You want to determine the magnitude of your potential liability. Having outside counsel in charge of this process ensures that it is independent and objective.

When an outside legal expert does the internal investigation, their findings may be legally privileged. Having them in charge of the investigation ensures that they are fully aware of the issue instead of learning about it while they’re interacting with government officials.

An internal investigation may learn whether there is a series of innocent errors of negligence on the part of your employees, such as when they bill transactions separately instead of bundling them. If you can track down double-billing to mistakes in the IT system or duplication of effort, you can avoid criminal charges. Likewise if it’s a misunderstanding on the part of a patient who reported suspected fraud because they think you’re marketing pharmaceuticals off label or received duplicate bills.

Produce All Required Documentation

Internal investigations are often sparked by a government subpoena for documents. Understand the scope of the requests for information. You can ask for clarification as to why they’re requesting certain files. For example, they shouldn’t have complete access to your electronically-stored information. When necessary, produce the requested non-privileged documents. You may need to bring in outside vendors to recover lost or corrupted files.

Start a Conversation

You can’t offer a potential resolution if you don’t know what they consider the offense to be, so, learn what their concerns are and what they are focused on. This may be different from what your internal investigation found. Their concerns may range from errors in medical billing codes to ghost billing to over-payment for services.

At the same time, you should be researching potential credits or reductions. If you can prove the issue is due to mistakes rather than fraud, you might eliminate potential damages or civil penalties.

You can negotiate everything from what is publicly reported to demands that you admit liability or wrongdoing. You could even ask for documents to be returned from the whistleblower. The government may also push for a Corporate Integrity Agreement or CIA. A good Medicare fraud attorney will fight to prevent worst-case scenarios like loss of your medical license or jail time. However, your business could still suffer if you’re excluded from federal healthcare programs.


The government takes allegations of Medicare fraud very seriously, and the threats are backed by hefty fines and criminal penalties. This is why it’s essential that you have an experienced Medicare fraud defense attorney by your side if you’re faced with allegations of Medicare fraud.

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Sunil Chandel

Sunil has been blogging about autos, consumer gadgets and home improvement ideas from a couple of years. When he is not writing, you can find him riding his royal enfield motorcycle, listening to music and showing off his football skills