After several Provider Relief Reporting periods, the government is holding true to its word and ramping up audit and investigation activities.
More providers are beginning to receive civil investigative demands related to use of COVID-19 funding, and they call for the production of documents that include corporate organization descriptions, patient information, contracts, and communications with employees, staff and other physicians, Derek Staub of Frost Brown Todd wrote in a blog for Bloomberg Law Thursday
CIDS also include written interrogatories (written questions that must be responded to in writing under oath) that can number in the hundreds (of written interrogatories).”
The Department of Justice named a Covid fraud enforcement director in March. Staub said providers are now beginning to get CIDs either in the mail or in person, despite the fact that most PRF claims submitted to the Health Resources and Services Administration are legitimate, wrote Staub.
But the reporting requirements are complex and require a level of accounting some providers, especially smaller ones, might not be experienced in, other legal experts have said.
The DOJ is looking for submissions that may violate the False Claims Act or anti-kickback laws. If a provider gets an investigative demand, said Staub, it means the government thinks the provider may have documents of interest to an investigation.
An attorney is crucial to asking the DOJ for an extension on the deadline for delivery of massive amounts of information, as well as sorting privilege and liability of the information requested, and other tasks.
“Many questions and requests regarding CIDs are either irrelevant, overly broad, or protected under privilege,” wrote Staub.
Locating, organizing and reviewing the information requested should be followed by the provider and attorney searching for a common denominator in the documents. Staub said the government is looking for things like patient referrals, lack of patient records, lack of medical consent, and fictitious testing regarding HRSA billing.
Staub said such preparedness and attention to detail can not only provide a successful defense but can reveal overpayments that must be returned within 60 days.
“Now is the time to conduct internal audits, follow up on internal complaints, revamp your compliance program, ask questions of your attorney, and above all, document,” wrote Staub.