Alleged Medicare Fraud and Abuse: How to Deal with Surprise Visits from Government Agents


There are a variety of Medicare compliance issues that health care providers are forced to deal with on a very regular basis.  These include false claims, overpayments, compliance programs, and billing errors.  Health care providers should implement an action plan to guide them in the event that a government agent shows up to inquire about a particular issue, or has a subpoena or a search warrant authorizing the seizure of documents.

 When developing an appropriate policy, there are several things that the organization should consider:

 1.      Determine what agency or agencies the government official or officials are from.  Is it OIG, DOJ, the state Medicaid fraud control unit, etc.?  Be sure to obtain copies of their cards and to verify their credentials.

2.      Call your attorney and report the presence of the agents and the names of their agencies. Ask the agents for a main contact so you do not need to duplicate medical and other records for each agency.

3.      Do not take a confrontational approach with government agents.  They are just doing their jobs.

4.      Do not attempt to interrupt or interfere with their investigation.

5.      Try to cooperate and collaborate – this is essential to resolving whatever issue brought the agents to your workplace.  For instance, try to explain what records are relevant and dissuade officials from seizing records that are irrelevant to the investigation.

6.      Do not assume that your organization will be accused of a crime.

7.      If the records being seized are electronic, provide them in CD or other unalterable formats.


By taking the above suggestions and creating a policy tailored to your workplace, you will be better able to handle unexpected government visits in the even that they do occur.  Preparation in advance is the key to dealing with Medicare compliance issues and claims.


© 2008 Parsonage Vandenack Williams LLC


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