It is an axiom long professed by criminal defense practitioners that “delay” in criminal investigations usually benefits the defense. In the health care context, however, the goal is to stay ahead of the curve, and prevent investigations in the first place. Health care providers are being “squeezed” by prosecutors and regulators employing new tactics to coerce civil settlements and criminal plea bargains. Accordingly, it is important now, more than ever, for health care providers to be proactive regarding compliance and billing issues in federally funded health care programs.

The first major trend of concern to lawyers who defend health care providers in investigations is the increasing resources being devoted to the investigations, both civil and criminal. At the federal level, there has been a substantial increase in the number of prosecutors and investigators looking at health care fraud, both at the Washington headquarters of the Department of Justice and at the United States Attorney’s Office for the District of New Jersey. The fact that most improper conduct in federally funded health care programs can typically be the subject of both civil and criminal sanctions (i.e., False Claims Act/civil monetary penalties; fines/incarceration), means that both civil and criminal investigators and prosecutors can be looking at the same conduct.

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