Since the passage of the Fraud Enforcement and Recovery Act of 2009 (FERA), the federal government has significantly increased the use of a powerful arrow in its investigative quiver the civil investigative demand, or “CID.” In many respects similar to a grand jury subpoena, CID allows a United States attorney to request huge volumes of documents and information from healthcare companies and compounding pharmacies in Tricare investigations under the False Claims Act (FCA).
DOJ Suspicious of Fraud in Tricare Billing
Tricare payments for compounded drugs have increased exponentially during the past three years and, suspecting that not all the billings are appropriate, the Department of Justice (DOJ) has targeted many small compounding pharmacy businesses in a number of states, including New Mexico, California, Florida, Texas, and Mississippi. The DOJ net is wide, sweeping up not only those who are guilty of wrongdoing but many others who have diligently tried to abide by the complex set of rules and regulations that are in place.
Retaining Experienced Counsel is Crucial for Defending Against CIDs
Compounding pharmacies should understand that if the business has been served with a CID, it is already a target of the investigation. The CID typically covers a broad swath of content and information, from short notes adhered to the side of a computer monitor to vast stores of email and other document information. What should a compounding pharmacy or other healthcare company do in the face of such a broad and dangerous CID request?
The most important first step in defending against CID requests is to contact an attorney who is experienced in defending pharmacies in Tricare investigations. You should never go into battle with the DOJ without an experienced “general.” The CID is a powerful tool/weapon. If you do not make your reasonable objections known early, you may be forced to surrender virtually every bit of information that you have on hand. Experienced counsel is necessary because:
- An experienced law firm, such as The Criminal Defense Firm, can craft an effective objection arguing that the CID is unnecessarily broad.
- An aggressive law firm can object to the CID to the extent it has requested information that is confidential or otherwise protected by privilege.
- A skilled law firm can sometimes establish that the CID has improperly requested “testimonial communications.” In other words, the purpose of the CID is to identify and produce documents and other evidentiary bits of information, not to elicit testimony itself. Some organizations have successfully defended CIDs on the grounds that the identification process calls for information that is not covered by FERA.
Have You Been Targeted in a Tricare Investigation? Get in Touch with The Criminal Defense Firm
Have you or your pharmacy been targeted by the DOJ or by a state agency in connection with compound drug prescriptions? Is the DOJ alleging other Tricare irregularities If so, you need to be represented by attorneys who understand the federal investigative process and who have experience with the FCA.
At The Criminal Defense Firm, we have extensive experience and provide aggressive representation for our clients. We encourage you to contact us for a free, confidential case evaluation. Our legal team draws on decades of broad experience. Some team members were even former prosecutors, so we know what you may be facing. We are prepared to do whatever it takes to help you win. To get started, call 866-603-4540 or contact us online today.
- Tricare Fraud Investigation: Defense of Physician against an Investigation by the Department of Defense and the U.S. Attorney’s Office for Alleged Tricare Fraud.
Result: No civil or criminal liability, case dismissed. - Tricare Fraud Investigation: Defense of Physician against an Investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for Alleged Tricare Fraud.
Result: No civil or criminal liability, case dismissed. - Tricare Fraud Investigation: Defense of Physician against an Investigation by the Department of Justice for Alleged Tricare Fraud.
Result: No civil or criminal liability, case dismissed. - Tricare Fraud Investigation: Defense of Marketing Group against an Investigation by the U.S. Attorney’s Office for Alleged Tricare Fraud.
Result: No civil or criminal liability, case dismissed. - Tricare Fraud Investigation: Defense of Nationally Operating Healthcare Company against an Investigation by the Department of Defense and the Department of Justice for Alleged Tricare Fraud.
Result: No civil or criminal liability, case dismissed. - Tricare Fraud Investigation: Defense of a Toxicology Laboratory against an Investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for Alleged Tricare Fraud
Result: No civil or criminal liability, case dismissed. - Tricare Fraud Investigation: Defense of a Toxicology Laboratory against an Investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for Alleged False Claims Act and Tricare Fraud.
Result: No civil or criminal liability, case dismissed. - Tricare Fraud Investigation: Defense of a Laboratory against an Investigation by the Department of Health and Human Services and the Department of Justice for Alleged Tricare Fraud.
Result: No civil or criminal liability, case dismissed.
Brian Kuester offers his extensive experience to counsel companies and individuals under civil or criminal government investigation. When resolution requires litigation, clients choose Mr. Kuester’s proven court and litigation experience.