The DEA leads healthcare fraud investigations involving prescription medications and fraudulent billing practices. At the same time, the Federal Bureau of Investigation (FBI) and the Department of Justice (DOJ) administer government programs such as Medicare and Medicaid, and DEA investigations play a significant role in prosecuting healthcare fraud in doctors’ offices, dentists’ offices, and pharmacies. If you’ve recently received notification of a DEA investigation into your healthcare firm, this post will explain your options.
DEA Healthcare Fraud Investigations
Prescription-Related Billing Practices
Under government healthcare programs, qualifying providers must meet strict billing compliance guidelines. Instances of double-billing, using the wrong billing code for a healthcare product or service, and bundling services are the types of cases for which the DEA might launch an investigation. Our recent post on billing fraud defense has more details about billing fraud charges and potential defense strategies.
Drug Diversion
The DEA has a Drug Diversion Program through which pharmacologists, special agents, and medical data analysts review controlled substances as part of healthcare fraud investigations. Physicians, pharmacists, and other healthcare professionals may face drug diversion investigations when suspected of fraudulently supplying controlled substances to a patient. The DEA also investigates falsification of patient records and theft of prescription drugs and equipment, such as prescription pads, under federal healthcare fraud laws.
Kickback Charges
The DEA also has broad powers under the Anti-Kickback Statute to investigate and prosecute kickback charges against healthcare providers. The federal statute prohibits specific financial relationships between professionals who can refer patients to a business partner for compensation. The payment and receipt of the kickback may constitute healthcare fraud and can lead to an investigation by the DEA, DOJ, and FBI.
DEA Administrative Searches Do Not Require Probable Cause
A DEA administrative search will occur in cases where a whistleblower makes fraud allegations. They will also conduct searches when audits detect anomalies in the billing data submitted to federal agencies. These administrative searches can trigger criminal investigations if data seized during the search indicates criminality. One of the significant differences between DEA administrative searches and searches in other federal investigations is that DEA administrative searches do not require probable cause if they’re investigating violations of the Controlled Substances Act.
DEA administrative investigations only require the following:
Your informed consent, or an administrative warrant confirmed through court approval
The challenge for medical providers is that this means DEA investigations can begin with little warning. The first time you learn of a DEA investigation could be when the DEA’s search team arrives at your medical office. Others may receive a DOJ patient file subpoena indicating an ongoing investigation.
Providers served with an administrative subpoena by the DEA should seek legal counsel from lawyers with experience representing doctors in healthcare fraud case investigations.
Defense Strategies in DEA Investigations
- Challenging the Sufficiency of the DEA Investigators’ Evidence
Your defense team can challenge the depth and accuracy of the DEA’s evidence against you. For example, do the DEA’s findings sufficiently prove intent to commit fraud? Is there a clear pattern of deception?
- Showcasing Compliance with DEA Regulations
Showing rigid compliance with the regulations ensures a robust defense of DEA allegations. Your defense team can audit your billing structures and communications and prove adherence to federal law as a powerful defense against DEA charges.
- Asserting Safe Harbor Protections
As regulated in 42 C.F.R. Sect. 1001.952, the Safe Harbor Protections safeguard healthcare providers against investigation and prosecution under specific rules and circumstances. For example, regulatory Safe Harbor protections often apply in alleged kickback schemes. One such safe harbor is the bona fide employment relationship ruling under Section 1128B of the Social Security Act, which protects amounts from employers to employees for covered items and services, under specific conditions.
FAQs on DEA Fraud Investigations
If DEA Drug Diversion Investigators Arrive at My Pharmacy, What Should I Do?
Federal law permits DEA investigators to inspect pharmacies during business hours as long as investigators do not disrupt business operations. If they arrive at your business, you’re likely subject to a random audit or an in-depth investigation. Stay calm and contact federal healthcare fraud defense lawyers immediately. Your lawyer can likely delay any audit until you have further details on any current investigation and resolve any concerns that might have triggered the initial inspection.
Do I Need to Comply with a DEA Subpoena?
Yes, the federal courts enforce DEA subpoenas, and your registration as a federal healthcare provider makes it mandatory for you to comply with their subpoena. Reaching out to DEA defense lawyers can help you determine the nature and scope of any legal action against you.
What Should I Do if a DEA Agent Requests that I Surrender My License?
You should contact a federal defense lawyer as soon as possible if you’ve received an official request from an agent to surrender your license. Sometimes, DEA field agents may give the impression that surrendering your DEA license can help prevent further investigation of a fraud claim. Only the DOJ or the Justice Department can end an investigation. Call a medical fraud defense law firm first if you’re considering surrendering your license during a DEA investigation.
Should I Allow the DEA Agents to Interview Me?
No. While it might be tempting to resolve the issue with the DEA by giving them any information they ask for, you should not allow them to interview you without first speaking with a defense attorney. When a federal agent visits you, either at home or at your medical practice, you’re likely subject to an investigation, and as such, anything you share can be held against you. Even if the DEA agents try to downplay the role of the interview or their questions, ask to speak with your defense lawyer before you answer their questions.
Can the DEA Report Me to My Licensing Board?
Yes, the DEA has the authority to report you to the licensing board if they believe you threaten public safety or if the federal government decides to indict you.
Call Lowther | Walker for an Urgent, Confidential Consultation in a DEA Investigation
If you are informed you’re under DEA investigation, receive a visit from a DEA agent, or have received a DEA subpoena, you have a limited time to speak with a federal criminal defense lawyer and protect your business and professional reputation.
Request a free, confidential consultation with Lowther | Walker’s experienced healthcare fraud defense team to learn more about your defense options. Our team is known for our experience defending medical providers in fraud investigations and for successfully defending our client in the largest healthcare fraud case the DOJ has ever prosecuted. We serve medical professionals nationwide, responding to DEA investigations with urgent defense services in Florida, Georgia, Alabama, Kansas, and Oklahoma.
Call our team today at (404) 806-7997 to book your free consultation.
Updated: May 2025