The 10 Biggest Legal Mistakes Physicians Make When Being Investigated for or Charged with Civil or Criminal Fraud

By Deborah A. Holzman, Esq.

Executive Summary

The rising increases in the cost of health care have led to all-out efforts to contain such costs. An important component of those efforts is a strategy to minimize the losses resulting from fraud and abuse in billing for health care services. It is therefore no wonder that thousands of physicians each year face investigations for real or imagined billing and related fraud. Such investigations, whether by regulatory agencies, law enforcement, or private insurers, can be costly, since they usually involve voluminous medical and billing records, and the costs associated with such investigations include not only legal fees, but also substantial staff and professional time, disruption of office routines, and expert fees. Physicians who are not prepared can make substantial, sometimes career-threatening, mistakes when facing an investigation or charges of civil, or worse yet, criminal fraud. Physicians facing fraud investigations need to explore all available rights, develop an action plan, and prepare family and staff for the rocky road ahead.

Mistake 1        Trying to Respond without Counsel

Mistake 2        Sparing Counsel Some of the Details

Mistake 3        Talking Too Much or to the Wrong People

Mistake 4        Failing to Understand Physicians’ Roles as Employers and Supervisors

Mistake 5        Failing to Cooperate with the Authorities

Mistake 6        Keeping Staff in the Dark

Mistake 7        Producing Records and Other Documents for Investigators without Appropriate Advice or Procedures

Mistake 8        Failing to Respond Fully to Application Forms

Mistake 9        Relying on the “Advice of Counsel” As an Absolute Defense

Mistake 10      Clarifying or Changing Information in Existing Records


The above has been excerpted from the SEAK text, The Biggest Legal Mistakes Physicians Make and How To Avoid Them.