Health and Human Services (HHS) Investigations

The U.S. Department of Health and Human Services (HSS) is responsible for the health and well-being of the public, and its focus is on advancing medicine, public health, and other social services. Since the HSS is solely a healthcare-based federal agency, much of its functions involve regulating the healthcare industry and overseeing federal healthcare programs. 

Another part of the HHS is the Office of Inspector General (OIG). The HSS OIG is the primary enforcement arm of the government for healthcare fraud, with offices located all around the country. The OIG is tasked with eliminating waste, fraud, and abuse in federal healthcare programs. 

Along with monitoring healthcare providers’ Medicare and Medicaid participation, the HSS can also cooperate with other federal agencies to investigate instances of federal healthcare fraud. 

If you are a healthcare provider or a medical practitioner, chances are that you receive funding from programs like Medicare and Medicaid. Because of the amount of money these programs give to healthcare providers, they are closely watched by the HSS OIG. 

If your practice comes under investigation by the HSS OIG, you could face hefty fines, lose federal reimbursements, and even be imprisoned. The second you learn that you are being investigated, you should take immediate action and contact a lawyer that specializes in healthcare defense.

How Does an HHS OIG Investigation Start?

The main area the HHS OIG targets is federal healthcare fraud, which it does by observing Medicare and Medicaid billing violations for patient services, medical supplies and drugs, and durable medical equipment (DME). Any violations of the False Claims Act, anti-kickback laws, or Stark Laws can trigger an investigation. The most common fraud allegations that get investigated by the HHS OIG include:

  • Billing for services that are unnecessary or not provided
  • Billing for unnecessary medication or DME 
  • Billing separately for services provided together
  • Billing for a more expensive procedure than provided
  • Double-billing Medicare, Medicaid, or a private insurance company
  • Prescribing medication without proper evidence of a medical need
  • Grant fraud 
  • Benefit enrollment fraud

Many situations can lead to an HHS investigation, such as routine audits for healthcare records, allegations of fraud or abuse, or a whistleblower claim. However, once an investigation has begun, the HHS OIG will try to find enough evidence to press criminal or civil charges. In the event the HHS brings charges, potential penalties include:

Both civil and criminal penalties can apply during an HHS OIG investigation, on top of state laws that can add additional penalties as well. If a healthcare provider is not careful in an inquiry, then there could be long-term career damage as a result.

What To Do When Contacted By Health and Human Services or OIG Investigator

Many healthcare providers do not take action soon enough when they learn about an HHS investigation. They either think that a situation is not too difficult, that it will disappear on its own, or they do not know how an attorney can help. No matter the reason for inaction, hesitation in the wake of an HHS investigation is a grave mistake. 

Many providers do not realize that the longer they wait to seek legal counsel, the more time the HHS has to put together a case that can lead to civil or even criminal charges. The second that a subpoena or notice of investigation is received, a provider should contact a lawyer.

One step that an individual or company under investigation can take is to find out why they are under investigation in the first place. Part of finding out about an investigation also involves learning whether the charges are civil or criminal. 

Another thing to keep in mind is to tell as few people as possible about the ongoing investigation. To build its case, the government will talk to the people around a company or individual under investigation, such as co-workers, family members, and friends. 

What Healthcare Defense Attorneys Can Do in a Health and Human Services Investigation

The second a healthcare provider learns of an HHS OIG investigation, and the first step should always be to contact a law firm with experience in healthcare fraud defense. An attorney can walk the practitioner or company through every step of an investigation, even build a case to defend against the government. This includes finding out what accusations are leveled against a healthcare provider or what charges may be pressed. 

A lawyer’s help even extends as far as visits from an HHS OIG investigator. Calling for legal counsel whenever an investigator visits can ensure that nothing incriminating is said during an interview. Finally, an attorney well-versed in healthcare fraud defense can gather all the relevant correspondences, witnesses, and workplace documents a healthcare provider needs to defend themselves from the HHS OIG.

At the Norman Spencer Law Group, we have a team of attorneys familiar with a wide range of healthcare defense cases. Our team has the experience you can rely on when you are faced with an HHS OIG investigation. If the federal government is investigating you or your company on allegations of healthcare fraud, do not wait to call us. We can schedule a free consultation over the phone, in person, or even online over ZOOM.