Houston OIG Investigation Lawyer

The U.S. Department of Health and Human Services Office of Inspector General (OIG) investigates healthcare fraud, abuse of federal programs, misconduct involving Medicare and Medicaid, and violations of federal healthcare regulations. These investigations can result in criminal charges, civil penalties, exclusion from federal healthcare programs, and significant financial consequences that threaten your career and livelihood. 

At Hilder & Associates, P.C., our Houston OIG investigation lawyer team defends healthcare providers, executives, small businesses, and contractors nationwide. Call (713) 234-1416 to schedule a free consultation.

Why Choose Hilder & Associates, P.C.?

Hilder & Associates, P.C. handles detailed and sensitive legal matters with the utmost care for our clients, understanding that your professional reputation and future are at stake. Our Houston OIG investigation attorneys bring decades of combined experience to every case we handle. 

Our firm develops a comprehensive and personalized strategy to achieve the best possible outcome for your unique situation. When you partner with us, we build a strong defense and work diligently to ensure that you move forward without further legal complications or damage to your professional standing.

Why Are You Being Investigated by the Office of Inspector General?

The OIG pursues investigations when it suspects violations of federal healthcare laws or misuse of government funds. Understanding the basis for an investigation helps you and our team prepare an appropriate response and defense strategy. Common allegations include the following:

• Billing for services not rendered or medically unnecessary procedures.
• Upcoding or unbundling medical services to increase reimbursement.
• Kickbacks or illegal referral arrangements with other providers.
• False certification of patient eligibility for federal programs.
• Submitting duplicate claims for the same service.
• Providing substandard care while billing for higher levels of service
• Violations of the Stark Law or Anti-Kickback Statute.
• Improper relationships with pharmaceutical or medical device companies.

The OIG may initiate an investigation based on whistleblower complaints, data analysis identifying unusual billing patterns, referrals from other agencies, or routine audits that uncover potential violations. Even unintentional billing errors or administrative mistakes can trigger serious investigations with severe consequences.

What Happens During an OIG Investigation?

OIG investigations follow a structured process designed to gather evidence and determine whether violations occurred. OIG agents include highly trained and credentialed special agents, investigative attorneys, and administrative investigators. 

As seasoned federal law enforcement professionals, they know exactly what they’re looking for and how to obtain it. Investigative activities may involve the following:

• Initial review of billing records, medical documentation, and financial transactions.
• Interviews with employees, patients, and business associates.
• Subpoenas for documents, electronic records, and communications.
• Site visits to your facility or practice location.
• Consultation with medical experts to evaluate care standards.
• Coordination with federal prosecutors if criminal charges are considered.
• Issuance of administrative sanctions or exclusion from federal programs.

Investigations can last months or even years, depending on the complexity of the alleged violations and the amount of evidence involved. The OIG may conduct its investigation quietly without your knowledge until agents contact you directly, or you may receive formal notification through subpoenas or document requests.

What to Do If An Investigator Contacts You

Your response to initial contact from OIG investigators can significantly affect the outcome of your case. Taking the right steps protects your rights and prevents self-incrimination: 

• Do Not Speak to Investigators Without Legal Representation: OIG agents are trained to gather incriminating statements, and even innocent explanations can be misinterpreted or used against you. Politely decline to answer questions and state that you wish to have your attorney present for any discussions.
• Contact a Houston OIG Investigation Lawyer Immediately: Time is critical when facing an OIG investigation, and early legal intervention can prevent mistakes that jeopardize your defense. We can communicate with investigators on your behalf, assess the scope of the investigation, and begin building your defense strategy right away.
• Preserve All Relevant Documents and Records: Do not destroy, alter, or dispose of any documents related to your practice, billing, or patient care. Obstruction of an investigation carries severe additional penalties under 18 U.S.C. § 1519, which prohibits destroying documents to impede federal investigations.
• Do Not Discuss the Investigation With Others: Conversations with employees, colleagues, or family members about the investigation can be discovered and used as evidence against you. Limit discussions to communications with your attorney, which remain protected by the attorney-client privilege.

Your cooperation with investigators must be strategic and coordinated through legal counsel to protect your interests. We manage all communications with the OIG while ensuring you do not waive important rights or provide information that strengthens the government’s case against you.

Potential Consequences of an OIG Investigation

OIG investigations can result in both administrative and criminal penalties, which can destroy careers and financial stability. Understanding potential consequences underscores the importance of mounting a vigorous defense:

• Exclusion from Medicare, Medicaid, and all federal healthcare programs.
• Civil monetary penalties of up to three times the amount of improper claims.
• Criminal prosecution for healthcare fraud under federal law.
• Loss of professional licenses and certifications.
• Mandatory repayment of improperly received funds.
• Prohibition from serving in leadership roles at healthcare entities.
• Damage to professional reputation and patient relationships.

Under Texas Penal Code § 35A.02, healthcare fraud is also prosecuted at the state level, potentially subjecting you to parallel state criminal charges in addition to federal consequences. Exclusion from federal healthcare programs effectively ends most healthcare careers, as providers cannot treat Medicare or Medicaid patients or work for facilities that participate in these programs.

Why You Need a Houston OIG Investigation Lawyer

An OIG investigation attorney offers expert legal advocacy, strategic guidance, and experienced representation throughout the investigative process. At Hilder & Associates, P.C., we navigate the complexities of federal healthcare regulations, understand the OIG’s investigative methods, and know how to mount effective defenses to challenge allegations or reduce potential consequences. 

Our role is to stand between you and federal investigators, protecting your rights while working toward the most favorable resolution possible under the circumstances of your case.

Providing a Legal Defense

Our Houston OIG lawyers craft defense strategies tailored to your case, challenging government claims, demonstrating regulatory compliance, and highlighting good-faith efforts. Our goal is to prove your innocence or show that any errors were unintentional, not fraudulent.

Analyzing and Preparing

Defending against OIG investigations requires meticulous examination of billing records, medical documentation, and business practices to identify defenses and refute allegations. We conduct a thorough analysis of all relevant evidence:

• Reviewing billing records alongside medical documentation for accuracy.
• Analyzing coding practices to ensure compliance with federal guidelines.
• Examining contracts and arrangements for potential Stark Law violations.
• Consulting medical experts on standard-of-care issues.
• Identifying procedural errors in the OIG’s investigation.
• Collecting exculpatory evidence and witness statements.
• Preparing responses to subpoenas and document requests.

Our preparation ensures that we present the strongest possible defense and counter the government’s narrative with facts and expert analysis. We leave no stone unturned in building your defense and identifying weaknesses in the OIG’s case.

Negotiating Resolutions

When possible, we negotiate with OIG officials and federal prosecutors to resolve investigations without criminal charges or permanent program exclusion. This may include repayment plans, corporate integrity agreements, or limited exclusions, often achieving far better results than individuals could on their own.

Assisting With Compliance

We help implement compliance programs, internal controls, and billing practices that meet OIG standards and prevent future investigations. Demonstrating a commitment to compliance can reduce penalties and show that violations were unintentional, while also assisting in addressing audit findings and correcting deficiencies.

Minimizing Consequences

Even when violations cannot be entirely disproved, we work to minimize the impact on your career and financial situation. We advocate for reduced penalties, shorter exclusion periods, arrangements that allow you to continue practicing in some capacity, and outcomes that preserve your ability to rebuild your professional life. Our goal is to protect your future and limit the damage caused by OIG investigations.

Consult a Reputable Houston OIG Investigation Lawyer Now

When faced with an OIG investigation without experienced legal representation, your career, financial security, and freedom are at serious risk. We have successfully defended healthcare providers, administrators, and entities against OIG allegations, and we understand how to challenge evidence, negotiate with federal officials, and fight for favorable outcomes.