Your role in someone else's practice
Many people pulled into health care fraud cases did not own the business or design its billing. They entered codes as instructed, signed notes, recruited patients, or managed schedules, and now investigators want to know what they saw. What separates a witness from a defendant is usually knowledge: whether you knew claims were false, or deliberately avoided finding out, rather than whether the paperwork was imperfect. Payments for referrals raise their own issues under federal and state anti-kickback laws, and those questions reach marketers and referral sources as well as providers. Your position can also shift as an investigation develops, so it should be checked rather than assumed.
When agents or the employer reach out
Agents from the HHS Office of Inspector General, the FBI, or a state fraud unit sometimes visit employees at home, and the questions may sound routine. You can decline to answer until you have a lawyer, and it is usually wise to. If your employer's counsel asks to interview you, remember that they represent the business, and ask whether you should have your own lawyer. Keep your own pay records, job description, and any messages in which you raised concerns or were told how to bill. Ask before copying patient files or company records, which carry privacy obligations of their own.
Planning the first steps
In a first meeting we work out your status and who is asking: a federal prosecutor, a state Medicaid fraud unit, a private insurer, or the employer itself. We look at whether you are more accurately seen as a witness, a whistleblower, or a subject, because the right response differs sharply among them. We also consider your professional license, since boards can act on their own track, and the risk of exclusion from federal health care programs, which can affect future work in the field. From there, the choice is whether to contact the government, prepare for an interview, or wait for more information.
