How to Defend Your Practice from a Healthcare Fraud Investigation


The best way to defend any practice from healthcare fraud investigations would be to prevent it from happening in the first place.The best way to defend any practice from healthcare fraud investigations would be to prevent it from happening in the first place. However, despite following fair practice protocols, it isn’t always possible to avoid unfavorable circumstances. To be able to successfully defend healthcare fraud claims against your business, the counterattack would require a well-structured strategy. The aspects we are about to discuss next are going to be key factors for creating that strategy.

Communicate with the Government Officials Via Your Legal Representatives

In most healthcare fraud related cases, the defending party is too late to react. This delay leads to the Department of Justice and other federal bodies like the Office of Inspector General, filing charges against them after conducting investigations of their own. This would mean that your business could be facing federal fraud charges, even before you get to have a say in the matter.

The owner/owners need to prevent that from happening by keeping communication lines open and reaching out to the DOJ, the OIG and other federal offices via their legal aid, as applicable. The HEALTHCARE FRAUD GROUP specializes in both defending and prosecuting Medicare and other healthcare related frauds, so their trial lawyers naturally have a wider perspective than the average defense lawyer. If you contact them as soon as a healthcare fraud investigation is launched against your business, they will reach out and communicate with the investigating federal/state departments, opening lines of communication and preventing the immediate filing of charges.

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Work with Your Lawyers to Identify Wrong Assumptions

Anyone can make a mistake, while a plaintiff might simply be trying to swindle the justice system itself. If their claims are indeed false, and the government department has initiated steps based on unproven assumptions. Your healthcare fraud lawyer should be able to identify them, as long as they have your complete assistance.

Understand that whatever you say to your hired lawyer is inadmissible in court, so do not withhold information that could help them bring the case in your favor. By keeping things transparent with your lawyers, you will raise their chances of finding gaps in ZPIC, CERT, RAC and MAC audit reports. If major mistakes are indeed found, the entire case could be dismissed almost immediately.

Understand the False Claims Act to See If It’s in Your Favor

Your lawyers will of course help you with deciphering the False Claims Act, but it is best if you are aware of the laws that regulate and enforce the Act also. For example, there are two very important requirements which a healthcare fraud claim must meet in order to be viable:

  • Verified proof that there was indeed a conscious intent by the defendant to break the concerned law
  • Verification of the fact that the defendant was either completely aware of the violation they committed, or was legally liable to be

We could go on about how to leverage facts in your favor during a trial, or question the lack of evidence during a meet, but that is what your trial lawyers are for. From the perspective of the business owner, everything we discussed so far should be sufficient to provide a proper introduction towards how to help defend a healthcare business against claims of fraud.

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