09/20/2025
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Top Interventions You Can Do If Accused of Health Fraud
Joe Flores JD APRN MSN CCRN-K LNC
Federal and TX Attorney and FNP-BC
National and Global Speaker
If a nurse practitioner (NP) is facing an investigation for health fraud, it's crucial to approach the situation with care and diligence. Here are ten steps that can be taken:
1. Consult Legal Counsel: Engage an attorney with experience in healthcare law and fraud investigations to understand rights and options. Providing Statements without council can cost you not only fines but can lead to criminal charges for lying to a federal agent.
2. Gather Documentation: Collect all relevant documentation, including patient records, billing statements, and communications that may pertain to the investigation. Your laptop, devices and hard files may be seized and held for a prolonged period of time. Back up all data and be ready to continue delivering care if allowed.
3. Understand the Allegations: Clarify the specific allegations being made to prepare an appropriate response. Denial or anger at being “targeted” solves nothing. Make sure you have competent council and an accountant plus a biller with a reputable character before starting a business and do not partner with anyone you have not performed strict due diligence on and certainly never partner with someone who has less to lose than you do. Too many NP’s think theyvneed a partner o or mentor controlling your business. Far too many nurse practitioners have been prosecuted because of third parties that were unnecessary or dangerous.
4. Review Policies and Procedures: Ensure compliance with healthcare regulations and internal policies to identify any potential areas of concern.
5. Cooperate with Investigators: While maintaining legal counsel, cooperate with the investigation to demonstrate transparency. Never debrief or give context to documentation without your lawyer by your side. Far too many NP’s
are under the belief they do not need a lawyer to their detriment. Simple audits and brief 1-2 hour consults protect you from contractual , employment law and state and federal law mistakes. Seek a Non Prosecutorial Agreement ( NPA) or a lawyer who can provide a reasonable and truthful explanation for certain documentation or actions by you or employees under your control.
6. Avoid Public Statements: Refrain from making public comments or discussing the case on social media to prevent further complications. Do not talk to anyone without your attorney’s monitoring of such activity. Anyone including a spouse or significant other can be a fact witness against you.
7. Prepare for Possible Outcomes: Consider potential consequences, including administrative actions, civil penalties, or criminal charges, and prepare accordingly. Too many NP’s live under the impression prosecution cannot happen to them. Lawyer up.
8. Seek Support: Connect with professional organizations for guidance and support during the investigation process without sharing your particular situation. Many NP articles and posts share their experience but read and listen not contribute to avoid any inadvertent admissions.
9. Maintain Professionalism: Continue to uphold professional standards and ethics in practice, regardless of the ongoing investigation. Whether the Board of Nursing, Medicare and Medicaid or other agencies or any agency has you under investigation you must ensure that the “show goes on”. Many investigations are resolved relatively quickly or a compromise may be reached. Cooler heads prevail.
10. Plan for Future Prevention: After resolving the investigation, implement changes to prevent future issues, such as additional training or policy revisions. Learn from the experience and be prepared. Too many NP’s enter into business without an accountant and legal counsel to protect them financially and legally.
Taking these steps can help navigate the complexities of a health fraud investigation while protecting the NP's rights and career.
Joe is a national speaker on issues where law and healthcare overlap. He has experience in civil, criminal defense, administrative and federal law matters for nearly 25 years.
Contact Info
[email protected] or 361-887-8670.
