How Should Healthcare Providers Respond to OIG Investigations?

 Posted on March 31,2021 in Medical License Defense

For healthcare providers such as doctors, nurses, psychologists, physical therapists, or pharmacists, notification that their practice is being investigated by an Office of Inspector General (OIG) can be very concerning. A state or federal OIG will look into reports of healthcare fraud or forms of waste or mismanagement involving Medicare or Medicaid. Depending on the results of an investigation, a provider may face a number of consequences, including exclusion from these programs or even criminal charges. To avoid these issues, it is crucial for providers to secure representation from an experienced attorney as soon as they are aware of an OIG investigation.

What Is the Office of Inspector General?

Different departments of the federal government and state governments have their own Offices of Inspector General. These offices are tasked with uncovering fraud, waste, or abuse that results in financial losses for government programs. Since Medicare is a federal program, the Office of Inspector General for the federal Department of Health and Human Services will investigate cases related to this program. Medicaid is administered at the state level, so the applicable state Office of Inspector General will usually investigate allegations of fraud or waste involving this program.

What Happens During an OIG Investigation?

In most cases, an OIG will investigate claims that a provider has committed healthcare fraud, which may include:

• Billing Medicare or Medicaid for services that were not actually provided
• Double-billing for services performed to receive payment through Medicare or Medicaid and a private insurance company
• Upcoding, which involves billing for more expensive services than those that were actually performed
• Unbundling, or billing for multiple separate services rather than one combined service
• Accepting bribes, kickbacks, or other forms of compensation in exchange for referrals

An OIG investigation may be initiated if personnel discover suspicious or irregular billing patterns, or complaints from patients may lead an OIG to look into a practice. Investigators may use a variety of methods to uncover information about a provider’s billing practices or other activities involving waste or mismanagement, including sending requests for information, conducting interviews with a provider or members of their staff, performing audits or inspections of a facility, or issuing subpoenas to obtain records from a provider.

Depending on the results of an investigation, a provider may face a number of consequences. These may include civil penalties such as fines or recoupment of payments made to a provider by Medicare or Medicaid. A provider may be excluded from participation in Medicare or Medicaid programs, removing their ability to provide services to certain patients. If there is evidence of healthcare fraud, a provider could face criminal charges. Penalties against a provider could also lead a state medical board to suspend or revoke a person’s medical license.

Contact Our Illinois OIG Investigation Attorney

If you are being investigated by a federal or state Office of Inspector General, you will need legal counsel to ensure that your rights will be protected. The Law Offices of Joseph J. Bogdan, Inc. can advise you of the best ways to respond to OIG personnel, and Attorney Bogdan will work with you to determine the steps you can take to avoid serious consequences and protect your ability to practice. Contact our Illinois medical license defense lawyer by calling 630-310-1267 to set up a free consultation.

Sources:

https://oig.hhs.gov/fraud/index.asp

https://oig.hhs.gov/exclusions/index.asp

https://www.illinois.gov/hfs/oig/Pages/Welcome.aspx