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DME Supplier Audits, Fraud Allegations, and Consequences

Key Takeaways: DME Supplier Audits You Are a Primary Target: With $1.9 billion in improper payments in FY 2024, CMS and its contractors treat DMEPOS suppliers as high-priority targets for audits and enforcement. Audits Escalate Quickly: What starts as a routine administrative review (MAC or RAC) can easily trigger UPIC, OIG, or DOJ investigations if [...]

What Should I Do When FBI Agents Show Up at My Home to Interview Me?

If the FBI visits your home or office to interview you about a potential crime, this guide explains the steps to take to protect your rights and prevent potential self-incrimination. Key Takeaways of Steps to Take When The FBI Visits You If the FBI approaches you for an interview at your home or workplace, keeping [...]

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 [...]

How CMS Finds Medicare Fraud

The Centers for Medicare & Medicaid Services (CMS) triggers an immediate fraud action when an allegation possesses indicia of reliability, under 42 C.F.R. § 405.370, The Centers for Medicare & Medicaid Services (CMS) detects fraud using advanced data analytics to monitor traditional Medicare claims. CMS algorithms identify anomalous billing patterns—such as sudden billing spikes—signaling potential [...]

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. [...]