Starnes Davis Florie

Healthcare Audits and False Claims Act Investigations

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The investigation and prosecution of healthcare fraud and abuse—misrepresentation, deception, deceit, or other wrongful conduct undertaken to obtain greater reimbursement than is appropriate—is a long-standing federal government priority that has been given even greater focus since the passage of the Affordable Care Act.  The FBI believes that health care fraud, including Medicare and Medicaid fraud, “costs the country tens of billions of dollars a year.”  No reputable healthcare provider wants to be accused of committing fraud or abuse, and yet it happens.

The latest enforcement tool is the aggressive use of “Big Data” dragnets and statistical analyses by health insurers, Recovery Audit Contractors (RACs), Zone Program Integrity Contractors (ZPICs), other contractors, and government agencies to identify fraud “by the numbers.”  Tipsters and whistleblowers as well as traditional investigative techniques continue to play a major role in enforcement as well.  Any governmental audit or inquiry should be treated as investigative and as threatening potential civil and criminal liability.

Defending fraud allegations and facing civil penalties or criminal indictment can be incredibly burdensome even to innocent and ethical providers. A sustained, meticulous defense, however, is absolutely necessary as the outcome of these types of allegations can be career-ending or company-destroying. The best place to begin your defense is at the beginning—that is, the minute a question arises. The lawyers of Starnes Davis Florie are experienced in this complex area of the law and are ready to help you.

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