Healthcare Enforcement Actions and Investigations

Whether responding to a federal subpoena, considering a voluntary self disclosure, facing a government audit or defending a qui tam action, we have already been there with numerous clients and are prepared to advise you on how best to respond today.

We understand that any investigation, audit or lawsuit is stressful and stretches the resources of large and small healthcare organizations alike. Effective responses to these situations necessitate experienced legal counsel with skill sets tailored to the specific needs of each case. At Troutman Sanders, we offer multi-disciplinary teams that can help ensure that you receive thorough, comprehensive solutions to your specific concerns.

Medicare and Medicaid Audits
We advise clients on audit requests in order to help them limit any repayments and identify signs that the audit could lead to a broader investigation. This requires nuanced dealings with the state or federal agency conducting the audit and the ability to support our clients’ internal resources in pulling records and preparing statistical reports.

Government Subpoenas
A subpoena is often the first sign that a client is under investigation, and an effective response is critical. Attorneys in our litigation and white collar criminal defense practices guide our clients through each step in assessing and responding to government subpoenas.

Qui Tam
The number of qui tam, or whistleblower, cases continues to increase in tandem with an increased focus on discovering healthcare fraud. With or without federal government involvement, these cases can be long and very contentious. Our attorneys are experienced in battling qui tam relators at every step.

Voluntary Self Disclosures
Our clients often must evaluate whether a particular case requires them to self-report to the Office of the Inspector General (OIG) of the U.S. Department of Justice (DOJ). We advise our clients on making appropriate decisions about self disclosures and the most effective process for cooperating with law enforcement officials.

  • Advising a group of hospitals on large-scale enforcement actions brought by the DOJ involving a variety of specific payment issues, including bundling/unbundling and upcoding;
  • Defending a publicly traded healthcare company in a qui tam case in which the DOJ intervened; the case was successfully resolved via settlement on favorable terms;
  • Advising a home health agency executive on a surprise interview by Federal Bureau of Investigation (FBI) agents at her home;
  • Representing a national chain of home health agencies in a dispute over entitlement to Medicare reimbursements for its branch offices in Virginia; and
  • Representing a psychiatric hospital against criminal allegations of fraudulent billings by the Virginia Medicaid Fraud Control Unit.