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Healthcare Newsletter

Unscheduled In-office Investigation

June 26, 2012

Question:

Jennifer,

An investigator showed up and my practice and took records while I was out.  My staff let them in.  What should we have done?

Dr. D

Answer:

Dr. D, this is unfortunately a common scenario I have been hearing and one I have to address.  Understanding how to respond to an unscheduled in-office investigation is a key element of a good compliance plan, and a policy that every office should have on hand and staff should be aware of.  Your staff should be made aware that regardless of what agency the investigator is from, the individual(s) should be requested to remain outside until the practice’s attorney has arrived and until all patients have been treated and released.  Should the individual(s) refuse, do not deny admission if the individual(s) show a search warrant, as refusing same may be construed as obstruction.  Management should be alerted immediately, as well as the practice’s attorney.  Our office would send a competent attorney to your practice at any time and as soon as contacted so long as you practice within a reasonable distance in NY or NJ.  Once the attorney has arrived, you should rely on counsel to assist in all communications with the investigators.  The attorney should request a copy of any search warrant, subpoena or supporting affidavits, and record the names and agencies present.   And, the individual(s) should be accompanied at all times during their time at the practice.  The entire visit should be recorded, times, items reviewed, areas searched, what has been seized, questions asked, etc.  After the site visit, all practice staff who interacted with the individual(s) should be debriefed. 

Now, who may be knocking on your door?   Medicare contractors, US Attorneys, the Office of the Inspector General, the Office of the Medicaid Inspector General, third party payors, the District Attorney, etc.  The list is somewhat extensive at this point in time because so many payors and agencies are looking at practices.  And, depending on who is knocking will greatly vary your potential liability.  If a Medicare contractor comes knocking, they may very well be collecting data to assess quality of care; if OIG comes knocking, you may be the target of a fraud investigation.  Regardless of who comes knocking, do not treat their visit cavalierly; protect yourself and your practice.  Do not proceed without counsel.  Further, many of you may be covered for civil defense of such a matter by your malpractice policy, and if you are not, you may want to call your carrier and request additional coverage so that you are – such is the frequency of these investigations. 

Of course one of the best ways to protect your practice from an on-site investigation and the aftermath is to stay in compliance, which starts with the right written policiesClick here to view our recommended compliance program documents.


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