If HHS-OIG contacts you, immediately secure specialized healthcare defense counsel and institute a company-wide document hold. Contact from the Department of Health and Human Services – Office of Inspector General (HHS-OIG), whether via subpoena, phone call, or surprise visit, requires urgent, strategic intervention to help prevent irreversible damage to your practice.
Actions to Take Immediately When the HHS-OIG Contacts You
You must immediately retain counsel, invoke your right to silence, freeze all records, and inform your staff to protect your practice from criminal charges and program exclusion.
- Contact an Experienced Healthcare Defense Attorney
Specialized counsel must intervene immediately to build a defense strategy and prevent massive fines or Medicare/Medicaid program exclusion under 42 U.S.C. § 1320a-7.
- Decline to Speak with Investigators Unrepresented
Refuse to tell your side of the story without counsel to avoid separate felony charges for making false statements to federal agents under 18 U.S.C. § 1001.
- Institute a Strict Legal Hold on All Documents
Immediately halt routine document destruction and preserve all records, as destroying or altering subpoenaed evidence triggers obstruction of justice charges under 18 U.S.C. § 1519.
- Advise Employees of the Investigation and Their Rights
You should inform employees of the inquiry and direct questions to defense counsel, ensuring you do not unlawfully interfere with a federal investigation.
Understanding Why the Office of Inspector General is Contacting You
The HHS-OIG is contacting you because they suspect your practice of violating federal healthcare laws such as the Anti-Kickback Statute (42 U.S.C. § 1320a-7b), the Stark Law, or the False Claims Act (31 U.S.C. §§ 3729-3733). The OIG does not conduct casual inquiries. They aggressively target fraudulent billing (18 U.S.C. § 1347), upcoding, and improper financial referral relationships.
Investigators will initiate contact through one of three primary channels:
- Formal Subpoenas Duces Tecum or Civil Investigative Demands (CIDs)
- Unannounced site visits to observe daily operations
- Formal phone calls with agents asking billing questions
Crucial Steps to Take Following HHS-OIG Contact
To survive an OIG inquiry, you must limit direct communication, enforce a rigorous litigation hold, and launch a parallel internal audit.
Limit Communication and Request Identification
Politely decline on-the-spot interviews and request agent credentials to avoid making unrepresented statements that can be weaponized against you under 18 U.S.C. § 1001.
Implement an Enterprise-Wide Document Hold
Issue a formal litigation hold to IT, billing, and clinical staff to preserve all data, because prosecutors can penalize the hiding or altering of records under federal obstruction statutes.
Initiate a Parallel Internal Audit
Direct your legal team to conduct a privileged internal audit of your billing practices immediately to identify your exact financial exposure and control the narrative before the government formalizes charges.
What to Avoid During an OIG Investigation
You must never alter medical records, discuss the case with unprivileged parties, or miss subpoena deadlines to avoid escalating a civil audit into a criminal indictment.
- Do not alter medical records: Modifying charts retroactively or adding addenda to justify billing codes is easily detectable and constitutes actionable fraud.
- Do not discuss the case with colleagues: Conversations with business partners or third-party billers lack attorney-client privilege and are subject to federal subpoenas.
- Do not ignore deadlines: Failing to produce documents by a subpoena’s strict deadline triggers immediate legal sanctions, contempt charges, and potential raid warrants.
Answers to Common OIG Contact Questions
Will my medical practice be shut down while the OIG-HHS conducts its investigation?
Your practice can typically remain open, but CMS can suspend your Medicare payments indefinitely based on a “credible allegation of fraud” under 42 CFR § 405.371. While you can technically operate, this payment suspension often cripples cash flow, making early legal intervention critical.
Are my employees allowed to speak with OIG-HHS investigators without my permission?
Employees have a legal right to speak voluntarily with federal agents, but they are not obligated to submit to on-the-spot interviews without a formal subpoena. You cannot retaliate against them, but you can offer independent legal counsel to protect their rights and prevent coercive interrogation tactics.
How long does a typical OIG-HHS healthcare fraud investigation take to conclude?
OIG investigations typically last from several months to multiple years, depending on the complexity of the billing schemes and coordination with the Department of Justice (DOJ). The timeline stretches as agents meticulously review sheer volumes of medical records before deciding on formal charges.
What is a Corporate Integrity Agreement (CIA) if I settle with the OIG?
A Corporate Integrity Agreement (CIA) is a strict 5-year compliance contract required by the OIG in exchange for avoiding Medicare program exclusion following a fraud settlement. It mandates external audits, compliance training, and strict reporting, with immediate financial penalties for any breach.
Can CMS suspend my Medicare payments based on an OIG inquiry?
Yes, CMS can suspend payments indefinitely under 42 CFR § 405.371 if the OIG establishes a credible allegation of fraud and the DOJ requests a continuation due to active proceedings.
Can information from a civil OIG investigation be used criminally?
Yes, evidence gathered through civil tools like a Civil Investigative Demand (31 U.S.C. § 3733) is routinely shared with criminal prosecutors. However, per U.S. v. Stringer, criminal investigators cannot manipulate the civil process to hide their intent, and subjects must have notice that the information may be used criminally.
Schedule a Free OIG Defense Consultation with Lowther | Walker
When dealing with the DOJ, the FBI, or the HHS-OIG, relying on a general corporate attorney or standard medical malpractice lawyer is a common mistake. You need a defense team that speaks the complex language of healthcare billing and federal criminal law.
Lowther | Walker is a national leader in healthcare fraud defense, representing healthcare providers, including physicians, pharmacies, DME suppliers, and hospital administrators across the United States. Led by Joshua Sabert Lowther, Esq. and Murdoch Walker, II, Esq., this defense team intervenes aggressively during the earliest stages of an OIG investigation.
Lowther | Walker’s OIG defense lawyers provide unparalleled strategic advantages:
- Immediate Shielding
They immediately stand between you and the OIG/DOJ, routing all agent inquiries through their office to prevent you or your staff from making self-incriminating statements.
- Unmatched Track Record
The firm has successfully defended clients in over 1,000 healthcare fraud cases, including securing a landmark acquittal in a $1.4 billion conspiracy case.
- Pre-Indictment Success
Lowther | Walker focuses on pre-indictment services, presenting exculpatory evidence early to demonstrate that billing discrepancies are administrative errors or software flaws, not criminal intent, thereby aiming to downgrade criminal targets to civil issues.
Schedule a confidential, free OIG defense consultation today to review your legal options.