Posted and filed under OIG Files.

We provide a lot of advisory and consulting services for the legal community.  Our Former HHS-OIG Special Agents have that very niche experience in the ability to speak healthcare fraud, waste and abuse as well as legalese.  In working with the various law firms on criminal, civil and administrative matters, it becomes clear that having legal representation that understands the complicated landscape of healthcare fraud investigations is more important than ever. With our work in this area, we have been able to gain insight to “the other side” of the investigative coin; the perspective of the defense.

We have gained a brand new respect for healthcare defense teams since expanding our suite of offerings to include consulting and advisory work with law firms.  Not to make this post a sales piece, but having inside experience that comes from OIG agents affords us the ability to think about where a government investigation may be going, and the knowledge to ask the kinds of questions that the government may be pondering.

In a recent meeting, we worked with a defense team on a strategy to convince a prosecutor to ultimately decline to continue the efforts to investigate and prosecute a client.  It was exhilarating to listen to the defense team discuss, with great granularity, the issues at hand.  These issues are complex, and involve numerous potential statutes, regulatory matters, as well as licensure implications. Having a team of quality attorneys who understood all of these things made for an interesting and informative discussion on the strategy. 

In the end, how a prosecutor will be swayed by the points to be made will remain to be seen; the goal is obviously to decline to prosecute.  Having a solid team that realizes the benefits of a consulting and advisory component to the defense strategy can only work to facilitate and foster a stronger defense.  From our perspective, identifying investigative lapses in the evidence work hand-in-hand to facilitate that strategy. 

By contrast, we recently ran into the polar opposite of a situation.  A provider’s legal representative failed to follow a very specific protocol for the submission of documents, and that failure cost the provider dearly.  It was a misstep that has the potential to cause a fair amount of financial harm to the provider, assuming the misstep is unable to be rectified.

We were asked to assist in obtaining additional legal counsel for the purpose of working through the misstep.  Part of what we do at Advize is to be a conduit and connector; the dividends still pay off in the end.  Passing business on to our network is part of being a good corporate citizen, and more importantly, part of maintaining a high level of ethics in an industry that is often times seeking to find its path of ethics and morality.

Without standing too long on the soapbox, the government is often very “dug in” on their opinions and beliefs with respect to prosecutions and the process.  As our retired OIG agents will often say, they too, had to make tectonic shifts in their thought process since retiring.  A good team of civil and criminal attorneys conversant in healthcare vernacular is just one strong prong in mounting a proper defense against a government investigation that may not have been complete or thorough.