Healthcare providers across the country are facing increased scrutiny from federal law enforcement agencies like the Health and Human Services Office of the Inspector General (OIG), the Centers for Medicare and Medicaid (CMS), and even the Department of Justice (DOJ). Providers based in Detroit are even more likely to be investigated for healthcare fraud charges due to the local team of healthcare fraud inspectors.
These investigations are inconvenient, and allegations of fraud can cripple a healthcare provider.
Many healthcare fraud cases and allegations begin when someone – usually a disgruntled current or former employee – brings evidence of purported wrongdoing to a law enforcement agency for review. Even if this is done out of revenge or to capitalize on a portion of any eventual recovery collected under the False Claims Act (31 U.S.C. § 3730(b)), the substance of that alleged healthcare fraud can pose a significant threat to a healthcare provider.
Preventing these whistleblower claims from ever making it to law enforcement is essential. While contractual provisions that forbid employees from making them will not be enforced in court, healthcare companies can incentivize internal reporting, instead. This allows the company to conduct an internal investigation to find out if there was wrongdoing or not, and to take any necessary steps to protect its interests.
However, these internal investigations...
PRESTONSBURG, Ky. — A third high-ranking employee has filed suit against Mountain Comprehensive Care Center, claiming she was fired for not following orders to submit false billing codes. Kristy St...