What You Should Do When You Are Under Investigation by the OIG/HHS

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Facing an investigation by the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS) is an extremely serious matter. To protect yourself, your business, and your future eligibility for government benefit programs (like Medicare), you need to take action before your investigation leads to civil or criminal charges.

If you own a medical practice or operate a business in the healthcare, pharmaceutical, or medical equipment industry, there is a good chance that you rely on federal government benefit programs including Medicare, Medicaid, and Tricare to cover the costs of serving your patients or customers. These programs pay billions of dollars to healthcare providers every year; and, due to recent high levels of fraud, these programs are now closely monitored by federal agencies, including the U.S. Department of Health and Human Services (HHS).

Facing an investigation by HHS or HHS’s Office of Inspector General (OIG) can have serious, long-term consequences. If your investigation leads to a criminal conviction, you could face insurmountable fines, imprisonment, loss of eligibility to collect federal program reimbursements, and other penalties. To protect yourself, you need to take action as soon as you find out that you are under investigation by HHS or the OIG.

About the U.S. Department of Health and Human Services (HHS)

The U.S. Department of Health and Human Services is a federal agency tasked with “enhance[ing] and protect[ing] the health and well-being of all Americans.” It seeks to execute this mission by providing for effective health and human services and fostering advances in medicine, public health, and social services.

As the nation’s primary healthcare-focused agency, a significant portion of HHS’s role involves oversight and enforcement of the regulations governing healthcare provider’s participation in the Medicare and Medicaid programs. It does this in conjunction with other federal agencies, such as the Centers for Medicare and Medicaid Services (CMS), and it even has a special “Medicare Operations Division” that is devoted to assisting in the resolution of Medicare-related disputes. HHS regularly pursues investigations of individuals and companies suspected of engaging in federal healthcare benefit program fraud.

About the Office of Inspector General (OIG)

The enforcement arm of HHS is known as the Office of Inspector General. It was established in 1976 in order to “identify and eliminate fraud, waste, and abuse” in Medicare, Medicaid, and other federal healthcare benefit programs. The OIG is comprised of numerous offices placed around the country, and each is dedicated to investigating, auditing, evaluating, and prosecuting healthcare providers suspected of federal program fraud.

Why You Need to Act Now if You Are Facing an OIG/HHS Investigation

Many individuals and company executives wait far too long to seek legal representation once they garner the attention of HHS or the OIG. They (i) don’t realize the gravity of the situation, (ii) assume that everything will be fine, or (iii) don’t understand how the right attorney can help at the initial stages of a federal investigation. Regardless of the reason, waiting any amount of time can be a major mistake.


With experienced representation, physicians, pharmacists, executives, and others can often end OIG/HHS’s inquiry during the investigation phase. This means not facing civil or criminal charges, and this means avoiding the possibility of crippling fines, long-term imprisonment, and other serious penalties. The longer you wait to take action, the longer OIG/HHS will have to build its case against you unimpeded, and the greater the chance that your investigation will lead to a civil enforcement action or criminal indictment.

What You Can Do Today to Protect Yourself in an OIG/HHS Investigation

If you are being investigated by the OIG/HHS for Medicare fraud or any other form of healthcare fraud, you need to take action. Here are five critical steps for preventing your situation from going from bad to worse:

  1. Choose the Right Legal Representation. When it comes to dealing with the OIG or HHS in a federal healthcare program fraud investigation, you need a team of attorneys who can level the playing field. This means choosing a law firm whose attorneys: (i) have decades of experience; (ii) have to experience not just in defense, but inside the government’s healthcare enforcement regime; and (iii) have an established track record of helping clients avoid civil or criminal charges.
  2. Find Out Why You Are Under Investigation. Until you engage with OIG/HHS, you don’t know what they know. While you may think you know what they are after, there is a good chance that they are acting on information of which you are not aware. In order to defend yourself effectively, you need to know for certain what you are defending against.
  3. Find Out if the Investigation is Civil or Criminal. This, too, is critically important. If the investigation is civil, your legal team will focus on keeping it that way. If your case turns criminal, that means that prison time is now on the table.
  4. Keep Quiet about the Investigation. At this point, you do not want to discuss your OIG/HHS investigation with anyone other than a member of your legal defense team. Friends, neighbors, co-workers, business partners are all people from whom the government’s investigators will attempt to extract incriminating information. You do not want to do anything that could come back to hurt you, and that includes making admissions or sharing information that could end up in the government’s hands.
  5. Build and Execute a Comprehensive Defense Strategy. All of this leads to the overarching principle that, when facing an OIG/HHS investigation, you need a targeted and comprehensive defense strategy. By the time when you find out that you are under investigation, the government has already started building its case against you. You don’t have time to waste, and you cannot afford to skip steps or make other mistakes that could jeopardize your defense.

How to Choose the Right Defense Team for Your OIG/HHS Investigation

While you need to act quickly, you do not want to be hasty when it comes to choosing your legal representation. This choice could have a significant impact on the final outcome, and it could mean the difference between convincing the OIG/HHS to drop the investigation and defending yourself against criminal allegations at trial.

Here are 10 questions that you can ask to help determine if a law firm is a right choice for your OIG/HHS investigation:

  • How much experience do your attorneys have in OIG/HHS investigations?
  • Do your attorneys have experience as former healthcare fraud prosecutors?
  • Are your attorneys familiar with the Medicare billing system and the federal healthcare benefit program regulations?
  • Will your firm assign senior attorneys to my case? Or, will I be working primarily with junior associates or paralegals?
  • How often are your attorneys able to convince the government not to press civil or criminal charges?
  • How often do your attorneys represent clients at trial?
  • What is your firm’s approach to developing a defense strategy for an OIG/HHS investigation?
  • Do your attorneys have the time available to fully represent me (or my organization) throughout the course of the OIG/HHS’s investigation?
  • How quickly can your attorneys make contact with the OIG/HHS?
  • What are the possible outcomes in my case, given the current status of the government’s investigation?

An Immediate Action Plan: The Criminal Defense Firm’s Emergency Defense Package

We cannot stress it enough: If you are under investigation by the OIG/HHS for Medicare fraud or another form of healthcare fraud, you cannot afford to wait, and you cannot make mistakes. To help our clients take action immediately, at The Criminal Defense Firm we have developed an “Emergency Defense Package” designed to help physicians, healthcare providers, and others in the medical industry take control of their OIG/HHS investigations. Our Emergency Defense Package contains critical information that you can use to make smart decisions and avoid dangerous mistakes in order to aid in your defense.

Our Emergency Defense Package includes:

  • General Protocols: What to Do
  • Instructions for Management: How to Deal with Agents
  • Instructions for Management: How to Deal with Employees
  • Instructions for Employees
  • Document Retention Forms
  • Compliance Examination Instructions
  • Important Contact Information

To receive your copy of our Emergency Defense Package, contact us for a free, confidential case evaluation today.

Additional Resources for Healthcare Providers Facing OIG/HHS Investigations

Along with our Emergency Defense Package, our attorneys have also published a number of free resources for healthcare providers who are facing OIG/HHS investigations. For more information about what to expect and what you need to do to protect yourself, we encourage you to review:

Schedule Your Free Case Evaluation and Get Our Emergency Defense Package

To get started defending your OIG/HHS investigation, contact The Criminal Defense Firm today and request a free case evaluation plus your copy of our Emergency Defense Package. Our team of experienced defense attorneys and former healthcare prosecutors is standing by, so call 866-603-4540 or get in touch with us online now.

This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Reading of this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. The Criminal Defense Firm is a Texas firm with headquarters in Dallas.
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