The Office of Inspector General (OIG) is charged with overseeing programs of the U.S. Department of Health and Human Services. When there are allegations of fraud, abuse, or misconduct by a healthcare provider in regard to these programs, the OIG may step in and perform an audit or investigate the claims.
At The Callahan Law Firm, our OIG appeal and reinstatement lawyers can help you understand your rights before, during, and after an action is taken by the agency. It is imperative to work with an attorney as soon as possible if you are being investigated by the OIG to ensure the best possible outcome in your case. Contact our office today at (312) 209-9394 to schedule a confidential consultation directly with a member of our legal team.
What Triggers an OIG Investigation?
An investigation by the Office of Inspector General (OIG) is frequently triggered by a complaint. However, inquiries may also be initiated by information submitted by a healthcare provider, billing data, or a Whistleblower claim.
It is important to know that some audits are systematic, meaning they are not triggered by complaints. Investigations, on the other hand, are generally started as a result of allegations of fraud, abuse, or wrongdoing. They can be submitted by an individual or referred by another agency, such as the Department of Justice or the U.S. Government Accountability Office.
What Kind of Authority Does the OIG Have?
The Office of Inspector General has sweeping authority over programs under the U.S. Department of Health and Human Services. The OIG can subpoena financial and medical records from your office. Failure to comply with the subpoena can result in additional penalties.
Additionally, the OIG can determine that you should have a Medicare exclusion. A Medicare exclusion can be highly damaging to your practice since it can prevent you from participating in any government-funded health program. Eventually, this may result in a substantial loss of revenue.
What Are Civil Investigative Demands?
If you have allegations of fraud or misconduct lodged against you the OIG may send you a Civil Investigative Demand (CID). A CID is an administrative subpoena used by federal agencies to help gather information related to an investigation. A CID may be sent to the party being investigated or to a third party with information related to the investigation. It is critical to respond to CIDs promptly and accurately to avoid further penalties.
Appealing an OIG Decision
Healthcare providers may have the right to appeal an exclusion from a public program. It is important to understand the requirements for the appeal, as you may only be allowed one opportunity. An attorney can help ensure the proper steps are taken to protect your enrollment.
Contact Our Office for a Case Evaluation
If you have received a Civil Investigative Demand, a subpoena, or information that you are being investigated by the OIG, contact our office to schedule a confidential consultation. Call (312) 209-9394 to speak with an attorney about your rights after an audit and your responsibilities during an investigation.
