When someone is facing a medical fraud inquiry, the first thing to do is preventing that investigation from resulting in criminal charges. It’s recommended that you hire a health care scam defense lawyer immediately. Based on the incidents of the case, there are many ways to defend you, which only a qualified lawyer knows.

If you work or own a health care facility in the US, you are vulnerable to charges pressed by the government even though you have given your best for the care of ailing patients. You might not be at fault at all, but with the rampant misuse of Medicare, Tricare, and Medicare systems, you’re typically perceived as an offender in the eyes of law.

These days medical fraud inquiries are common, whether set off by a cost-for-service review or any whistleblower’s accusations, most of these investigations would prove heavy on your wallet, disturbing, and invasive. If you lose the case in a court of law, it would mean paying hefty legal fines and even imprisonment. This is where defense lawyers come to your rescue.

According to an article published on forbes.com, a patient experiencing a poor outcome of treatment does not necessarily mean medical negligence or fraud. Therefore, here are five defense tactics to prevent health care fraud:

1. Tell your story to show that you’re innocent

Source: ISHN.com

During such investigations, it is common for the US Department of Justice (DOJ) or for that matter the Office of Inspector General (OIG), to come for you. Then, you can decelerate the inquiry and prevent the authorities from pressing charges. How are you going to do that? Well, the logical thing to do is telling your side of the fact or story to show that you are not the perpetrator of any medical fraud. It will help in slowing down the investigation, as you can buy some time to prove your point. It’s known as an intervention.

Now, what does the intervention of an inquiry mean? According to defense lawyers, it signifies using their wide experience to communicate efficiently with the prosecutors and agents, understating the kind of inquiry and persuading that there are two sides to every story. One should listen to both the parties and not just hear out a one-sided tale.

Once the authorities know your defense lawyer is working on your case, the inquiry process will slow down, and in this way; you get time to build your defense approach.

2. Delve deeper to understand the laws of the land that protect you

Source: Human Rights Law Centre

Though the Anti-Kickback Statute, False Claim Act, or for that matter Stark Law is used against health care facilities in the country, these laws have a broad scope and are conditional on numerous regulatory and legal exemptions. Let us explain this point with the help of an example.

For instance, when it comes to the False Claim Act, it needs clear and specific proof of particular intention to break the law or for that matter awareness that what activities you performed were incorrect or unlawful to set off criminal responsibility. It means that you have enough scope to prove that you are innocent and did not do anything on intent. If you have more questions about defending yourself, look up websites like healthcarefraudgroup.com or similar platforms to get all your queries answered.

3. Point out flawed methods, assumptions, and conclusions

Source: RevCycleIntelligence

When it comes to medical fraud investigators, prosecutors, or agents with vast experience, they too can commit mistakes just like any other normal human. Moreover, as far as cases involving inquiries by RAC, MAC, or ZPIC inspections, there are instances when auditors jumped to flawed conclusions depending on faulty auditing tactics and suppositions. That is why you need a defense attorney to point out these flaws and turn the table in your support.

4. Know when the authorities are violating their authority

Source: ACLU of Texas

You should always cooperate with the government inquiry, no doubt, as you can benefit from it. Then, you also should be aware that when the authorities are misusing their authority. There is a thin line of difference between cooperation and providing the prosecutors with incriminatory details that might work against your favor. This way, your cooperation will not save you from the charges pressed by the agencies.

Therefore, when federal agents come to your residence, knocking your door, or when the OIG sends a subpoena through the mail, you are within your rights to know and defend yourself, as the agents are violating their power or authority.

It is indeed true that OIG and DOJ have extensive investigatory supremacy, but there are constitutional, lawful, and regulatory restrictions as to what extent they can head. Therefore, knowing your rights is essential and if you are unsure, always consult your defense lawyer.

5. Keep the charges civil

Source: American Civil Liberties Union

The government will try to press charges, but you need to shift its focus by keeping the charges civil. This is when your legal defense attorney will help you. As far as the legal standards of criminal and civil cases are concerned, they differ in many ways. Besides, restricting your possible exposure or vulnerability, trying to keep your case civil might enhance the possibilities of working out a favorable or fair resolution before the trial.

No matter what the circumstances of your case are, if the authorities have pressed charges against you, the best thing is appointing a certified and experienced defense lawyer to fight for you. You will need to defend yourself at any cost and by all possible means. Do not leave out any options. If you have queries or doubts, ask questions and your attorney will help you to clear your doubts. There is no point in hesitating and telling every detail, big and small, to your lawyer. Even the most trivial things matter in these cases. In simple words, do keep back or hide any information related to the case.


Now that you have these tips handy, use them to protect yourself from health care fraud investigation. If you haven’t done anything wrong, there is nothing to fear.

There are many people who have made a career out of claiming compensations in different states. They have also tied up with notorious personal injury lawyers to help them file fraudulent claims and cases. This is why as a professional medical practitioner you should be careful and always hire the best legal defense team to help you if and when such incidents arise. If you wish to know about how you are going to build your defense and get the best legal help, please visit website.