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Tales of Two Fraud Investigations Terminated and the Lives Blessed by Truth

February 12, 2018

I have to tell two short stories today. As a former English teacher, I encourage you to allow your imagination to bring the realities of theses people's lives to life.

Yesterday, I was in the South for meetings with the FBI and DOJ regarding healthcare fraud investigations that had been ongoing over the past year. We were informed that both investigations were declined for prosecution - my clients, their wives, their children, their employees, and the thousands of patients all saved the horrid experience of federal criminal prosecution defense. A delayed flight home gave me time to reflect on how we got to this point.

The bottom line - the truth, no matter how complicated or humanly negligent, set these people free.

Over a year ago the primary investigating FBI and HHS agents stormed practices, interrogated employees and patients, demanded mountains of documentation, and were genuinely convinced they had dead ringer convictions coming. Why were they so convinced? Mainly it was because payors had told them "there was no way a provider could have innocently have made those mistakes" and because former employees were angry for getting fired or lied to hide their own mistakes while working at the practices. The amazing fact is that all voices crying foul were silenced by two things - the claims/payor history of the practice and the knowledge of how to truthfully interpret their meanings! All the time, research, and effort was worth it!

How did we prevent the terrible impact on all the lives involved in these matters? We dispelled ignorance through hard work and enlightening our enemies.

Sure, it was a great deal of work to evaluate, correct, and bring into compliance $40+ million dollars of claims over 5 years and 40+ payors, but these two doctors walked out with heads high, licenses in take, practices operating, in good standing with all payors, and armed with more knowledge then they ever dreamed to rebuild their practices and lives.

Those were two victories I will not soon forget, because I have pictures of their children sitting on my desk.

Originally published on LinkedIn, 01.17.17.


Stephen Bittinger is an attorney with Nexsen Pruet's Health Care Practice Group. Stephen has represented physicians across multiple disciplines, home health agencies, nursing facilities, medical groups, medical facilities and medical consultants in Medicare appeals, Medicaid appeals, RAC audits, ZPIC audits, federal regulatory termination and exclusion proceedings, False Claims Act defense and prosecution, and healthcare litigation.

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