Rivas Goldstein, LLP

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Texas Attorneys Representing Clients Under Investigation By Qlarant, The FBI Or The OIG

Health care entities and individual providers are scrutinized constantly by local, state and federal agencies. This constant investigation can lead to regulators and law enforcement conducting thorough and invasive investigations into medical practices. The FBI, the Office of Inspector General (OIG), the Medicaid Fraud Control Unit or Qlarant often head these investigations.

At Rivas Goldstein, LLP, our Austin lawyers represent medical professionals and health care entities who are facing an investigation from regulators. We will protect your interests at every stage of the inquiry, from the first contact with investigators through any administrative and criminal proceedings that may arise. If you have received a letter or some other civil investigative demand from government agencies or your office was already raided by law enforcement, please reach out to our firm as soon as possible.

Knowledgeable Guidance For Many Types Of Medical Providers And Professionals

Our Austin office assists many types of health care clients, including:

  • Home health and hospice care companies
  • Individual physicians, group practices and hospitals
  • Medical billing and coding companies
  • Free-standing emergency centers and comparable facilities
  • Private ambulance companies
  • Hospice companies

Federal agencies and investigators aggressively pursue health care entities for many types of Medicaid and Medicare fraud, including unlawful activities involving:

What Are The Most Common Forms Of Health Care Fraud And Abuse?

Health care fraud can be committed by several different parties. While some instances of health care fraud are perpetrated by patients or other non-professionals (specifically those impersonating health care providers), many others are carried out by health care providers. Where providers are concerned, the most common types of fraud are:

Drug diversion: Drug diversion occurs when health care providers write unnecessary prescriptions for their patients. Not only is this practice fraudulent, but it can be dangerous because it puts patients at risk of severe, if not fatal, health consequences.
Kickbacks: Paying, receiving and soliciting kickbacks are highly illegal behaviors in the health care industry. When health care providers pay kickbacks, they are essentially bribing other parties to refer patients to them. When health care providers receive kickbacks, they accept bribes from other parties to engage in actions that would advantage their business. When health care providers solicit kickbacks, they seek to create an advantageous situation for themselves by enriching other parties. While kickbacks may enrich health care providers and companies, they harm patients by making services more expensive, encouraging them to receive unnecessary services and requiring them to use certain facilities.
Overbilling: Overbilling happens when health care providers stick insurance companies or patients with excessive or unnecessary charges. Sometimes, overbilling takes the form of upcoding – charging for services more complex than those rendered. In other situations, overbilling takes the form of charging for services that were unnecessary or never provided.
Unbundling: When patients receive multiple services, these are supposed to be bundled for billing purposes. Unbundling, then, happens when health care providers split patients’ bills into pieces, overcharging Medicare, Medicaid or insurance companies. Rather than getting reimbursed for whole bills, health care providers instead get reimbursed for separate services or procedures.

How Our Texas Health Care Investigations Attorneys Help

Our firm takes immediate action to open a line of communication with the law enforcement agency to understand the investigation details better and help clients understand the next steps. Our next step is to get any records or documents that the agency may have seized during their investigation. With these confiscated documents returned, clients under investigation can continue running their business while the investigation moves forward.

We then work to identify who or what the real target of the investigation is and the nature of the investigation. This complete understanding of the investigator’s goals allows us to narrow the scope of the investigation and make it more manageable for clients. Finally, we may complete an internal investigation, which may necessitate the hiring of investigators, statisticians and other experts.

Contact An Experienced Qlarant/FBI/OIG Investigations Attorney

Contact Rivas Goldstein, LLP, now if you face an investigation or if your office has already been raided. Please call us at 800-761-5190 or contact our Austin law firm online.