Responding to Investigations and Audits

Posted by on Thursday, February 19, 2015

In an earlier blog post, we discussed how to avoid fraud and abuse pitfalls by identifying and guarding against practices and conduct that are typically viewed as fraudulent and abusive.  If a practitioner does become the subject of an inquiry or audit, it is important that the practitioner respond and cooperate accordingly.  Ignoring or otherwise refusing to cooperate with investigators auditors will invariably make what is often a very manageable situation much worse.  If there is confusion as to what the investigator or auditor is requiring, or as to the implications and impact of the inquiry, practitioners are strongly encouraged to consult with legal counsel familiar with and experienced in dealing with practitioner investigations and audits.

It is also very important for practitioners to heed warnings and educational correspondence from investigators and auditors.  Once a practitioner is educated or warned regarding a particular practice or problem, any similar conduct in the future that once may have been previously viewed as mere abuse or waste, would now likely be considered fraudulent conduct following the warning.  This is because the practitioner is presumed to have actual fraudulent intent for engaging in similar conduct in the future as a result of being previously warned.  If a practitioner does not agree with a particular warning or educational correspondence, the practitioner should respond in writing to the auditor or investigator documenting the disagreement.  If the issue cannot be resolved, practitioners are strongly urged to seek legal advice.