Responding to CMS Investigation

Watch out for 3rd party companies that are hired by CMS to investigate Medicare/Medicaid usage by private offices. Usually three investigators ring your bell and walk in unannounced. They attempt to overwhelm and intimidate your office so as to immediately obtain the desired patient charts. They are very aggressive and threatening. They have no badge or subpoena authority. They do not have warrants. While you do have an obligation to provide requested charts, as an agent from the government, you do not have to drop what you are doing and inconvenience your patients. You are entitled to call your attorney and have him or her schedule an appointment to return. You do not have to agree to an on the spot interview without your attorney present. They often attempt to trick the practice by letting them know “the cause” of the investigation. This is often a smoke screen for the actual cause. By then, attempting to cooperate, and lulled into a false sense of security, you have already “spilled the beans”. They also aggressively attempt to interview the practice’s staff, including your nurses, medical assistants, PAs, NPs, PTs, you name it. Let me make this clear, I am not saying that you or your staff should not cooperate with them, only that it should be with your attorney present. Should they come, call your health care attorney. Have that attorney call the investigator immediately. Have your attorney arrange a meeting and a copy of your charts. Do it the right way!

Yours,

Larry Kobak, Esq.