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Chapter 5. Government Investigations

Any substantial False Claims Act (FCA) lawsuit is accompanied by a government investigation. FCA cases are investigated primarily by the U.S. Department of Justice (DOJ), which deploys hundreds of assistant U.S. attorneys (AUSAs) and trial attorneys to investigate allegations of healthcare fraud. The prosecutors work with scores of federal agents from the U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG), the Federal Bureau of Investigation (FBI), and numerous additional agencies to investigate a wide variety of healthcare fraud cases, including allegations raised in qui tam lawsuits. Healthcare fraud has been an active area of enforcement for federal prosecutors for more than 25 years, and with a track record of securing tens of billions of dollars of recoveries to federal healthcare programs through FCA investigations, there is every reason to expect that the DOJ will continue robust healthcare enforcement efforts in years to come. Healthcare providers should be aware of the basic steps involved in a typical FCA investigation so they can be prepared when an agent comes knocking with a subpoena.

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