Fraud & Abuse Investigations

Where is there a legal or medical meaning for the term ‘Abuse”?

The Issue: Healthcare insurers often have an entire division devoted to investigating and leveling “fraud and abuse” charges against providers. Usually called a “Special Investigation Unit,” its investigators are often former government agents working with in-house counsel.

A typical tactic of these investigators is to show up at a provider’s office and demand records. “Fraud and abuse” accusations against providers have the potential to destroy professional careers. They can also result in substantial repayment demands. Healthcare insurers retain the largest law firms in the country.

Our solution: Providers should not go it alone. They should hire seasoned fighters like Axelrod LLP to defend them. In fact, in trying a recent “fraud and abuse” case brought by Blue Cross and Blue Shield of Rhode Island to verdict, Axelrod and his co-counsel successfully defended their clients from this practice.