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Grand Jury Subpoenas in Healthcare Fraud Cases – What Medical Professionals Need to Know

Grand jury subpoenas are a court order compelling someone to testify or produce evidence for a grand jury investigation to determine if criminal charges are warranted. This post explains how healthcare professionals should respond to a healthcare grand jury subpoena. [...]

Why Healthcare Practice Owners and Providers Receive Target Letters and What to Do Next

Data shows the total new government and whistleblower healthcare fraud matters opened under the False Claims Act reached an all-time high of 1,402 in 2024. Healthcare practice owners across the United States are facing growing scrutiny from federal agencies like the Department of Justice (DOJ), the Office of Inspector General (OIG), and the FBI. A [...]

Medicare Fraud Investigations: Medicare Targets and Triggers for CMS Criminal Prosecutions

The Centers for Medicare & Medicaid Services (CMS), working alongside Unified Program Integrity Contractors (UPICs) and Medicare Administrative Contractors (MACs), triggers an immediate fraud action when an allegation possesses indicia of reliability, under 42 C.F.R. § 405.370, The United States National Healthcare Anti-Fraud Association has new data. It shows that taxpayers lose more than $100 [...]

What is an OIG Healthcare Fraud Investigation?

OIG (Office of Inspector General) investigations are independent inquiries conducted by oversight offices within government agencies to detect and prevent fraud, waste, abuse, and mismanagement. This guide is to help professionals facing an OIG investigation understand the next steps and the defense options. [...]

A Guide to DOJ Civil Investigative Demands

Key Statistics on Federal Enforcement Department of Justice 2024 data shows a record-high 1,504 civil investigative demands (CIDs) were issued under the False Claims Act. This represents a significant increase in federal scrutiny, marking CIDs as the primary evidence-gathering tool for federal authorities today. What is a Civil Investigative Demand? A Civil Investigative Demand (CID) [...]

A Guide to DEA Warrants

The Controlled Substances Act gives the DEA broad authority to request access to a healthcare business’s data. Because refusing to comply with a legal request to disclose information to the government can lead to additional penalties beyond those related to the initial inquiry, healthcare business operators should carefully review their legal obligations and rights under [...]