The Office of the Inspector General (OIG) recovers billions of dollars every year from health care fraud schemes. This year alone has resulted in over 900 exclusions worth $1.5 billion. This highlights how seriously the OIG takes their work to detect and prevent fraud, waste and abuse in health programs and operations.
Failing to not only implement best practices but properly detecting and preventing fraud from occurring has severe consequences for providers. When health care providers are faced with an OIG investigation, it’s crucial to understand enforcement actions in order to better know how to proceed.
Reasons for OIG Enforcements
OIG enforcements typically occur due to one of the following reasons:
When an OIG analyst flags unusual practices or patterns
When a whistleblower files a formal report
When a patient reports their provider or files a formal complaint
How to Protect Yourself in an OIG Investigation
To better protect themselves in an OIG investigation, health care programs should implement the following:
Conduct an Internal Investigation
If you are faced with an investigation, you should always conduct your own internal investigation. In the event that the government made a mistake during their findings, you want to be able to provide them with proof of your compliance.
Improve Compliance Programs
Examine your current compliance program and look for its strengths and weaknesses. Expand on what works and repeat that in other aspects, if possible. If there are parts of your plan that have issues, you’ll need to improve on them in order to ensure compliance.
Learn Why You are Being Investigated
With an attorney on your side, they’ll have the opportunity to reach out to the investigators to learn why you are under investigation and whether your case is a civil or criminal complaint. Knowing this information will be essential in how you proceed with your defense.
Hire an Experienced OIG Attorney
When you are faced with an OIG investigation, you need an attorney with extensive healthcare law experience. Because state and federal cases are widely different, your attorney must be familiar with current investigation procedures and have the expertise needed to handle your case successfully. If you are in an OIG investigation, reach out to the lawyers at Hendershot Cowart P.C. immediately. We can help you understand your case and strategize to come up with the best plan in order to protect your healthcare organization.
Call our experienced attorneys today at (713) 909-7323 or contact us online to discuss your case.