When a government agency or licensing board opens an investigation into you, your benefits, your professional license and your livelihood are at risk. We represent individuals and professionals in these proceedings, from HRA benefit fraud allegations to professional discipline matters, and we know how the agencies involved actually work. The difference between keeping a benefit or license and losing it is often decided early, before any formal charge is made.
You can call us at 212-233-1233 or email [email protected] to discuss your situation.
HRA Investigations
We represent individuals and healthcare providers facing HRA investigations into SNAP (food stamp) and Medicaid benefit fraud. These investigations can end in benefit suspension, overpayment demands and disqualification from government programs, and the consequences for future eligibility last.
Our HRA work covers Medicaid fraud defense for healthcare providers and individuals accused of fraudulent billing, and SNAP and food stamp fraud defense against allegations of benefit fraud and false claims. We represent clients at HRA administrative hearings on benefit determinations, negotiate to reduce or eliminate overpayment demands, help clients regain eligibility for assistance programs, and review the records and evidence the agency is relying on.
Professional Licensing Investigations
A professional license represents years of education and training, and a disciplinary proceeding can end a career. License defense requires knowing the government rules and the specific regulations that govern each profession.
We defend physicians and medical professionals against medical malpractice allegations and licensing violations, and nurses and healthcare workers against professional misconduct charges. We represent professional engineers in licensing and ethics matters and architects in design-related complaints, as well as lawyers, accountants, real estate agents and other licensed professionals. That includes fighting temporary license suspensions and restrictions.
Government Investigation Defense
Federal, state and local government investigations have their own procedures and deadlines, and they have to be followed carefully. We represent clients at government agency hearings and in administrative law proceedings, help businesses and individuals respond to alleged regulatory violations, manage discovery and document requests, prepare clients for government interviews and depositions, negotiate resolutions with the agency, and challenge adverse administrative decisions in court. We also represent whistleblowers who report government wrongdoing.
How an Investigation Unfolds
Government investigations move through predictable stages. Effective defense requires action at each one; waiting until final action to engage counsel usually means the case has advanced past the point where a defense can do much good.
- 1
Initial inquiry
The agency learns of a potential issue through a complaint, an audit, data analytics or a referral, and an initial review decides whether to open a formal investigation.
- 2
Investigation opened
The agency opens a case file and assigns investigators. The target may or may not be notified at this stage.
- 3
Document gathering
Subpoenas, requests for information, audit demands and similar tools are used to collect records.
- 4
Interviews
Investigators interview witnesses, including the target and people close to the target.
- 5
Analysis
The investigators analyze the evidence and develop their conclusions.
- 6
Preliminary findings
The agency may issue preliminary findings or a notice of intended action.
- 7
Response
The target generally has a chance to respond before final action.
- 8
Final action
A charge, a fine, license action, or closure of the investigation.
- 9
Administrative appeal
Where available, the target can challenge the final action through administrative proceedings.
- 10
Judicial review
Court review may be available once administrative remedies are exhausted.
When the Notice Arrives
The first days after an investigation notice matter more than most people expect, and early missteps can do lasting harm. Even well-intentioned cooperation creates problems if it is not properly structured.
Do not respond informally to the agency, produce documents in response to informal requests, or attend an interview before consulting counsel. Preserve every document and communication that might be relevant, and do not destroy or alter any record, even a routine one. Do not discuss the matter with anyone other than counsel, and do not contact potential witnesses to discuss what they might say.
Counsel at Interviews
Investigators usually want to interview the target, and the interview is often the turning point of the case. What is said is typically recorded and used as evidence later. Any inconsistency between the interview and the documents becomes a focal point. A false statement to a government investigator can be a separate crime. A voluntary disclosure sometimes earns leniency and sometimes creates new exposure.
With counsel in the room, the target gets advice on whether to answer a particular question, help framing answers accurately, a witness to what was asked and said, and the ability to invoke a privilege or end the interview if necessary. Preparation before the interview means the target knows what to expect.
Privileges and Their Limits
Several privileges may protect information from disclosure. Each has specific elements and exceptions, and each can be waived inadvertently through careless disclosure.
| Privilege | What it protects |
|---|---|
| Fifth Amendment | Protection against self-incrimination. It can be invoked in administrative as well as criminal proceedings, though with different consequences. |
| Attorney-client | Communications with counsel for the purpose of legal advice. |
| Work product | Materials prepared in anticipation of litigation. |
| Marital | Communications between spouses, in some circumstances. |
| Medical | Medical information, though often less robustly than the other privileges. |
Self-Incrimination
An investigation with possible criminal implications raises a specific problem: information given in an administrative proceeding can be used in a later criminal one. The Fifth Amendment can be invoked in administrative proceedings, but doing so may carry adverse civil consequences, such as an adverse inference, even though the invocation cannot be used against the witness criminally. A statement compelled under a grant of immunity cannot be used against the witness in a criminal case but can have other consequences. Civil regulators and criminal authorities sometimes share information, so an administrative disclosure can find its way into a criminal investigation. When parallel civil and criminal investigations are possible, advice about cooperation has to account for both.
Settlement
Many investigations resolve by settlement rather than full administrative proceedings. The terms that matter are the nature and extent of any admissions, the penalty or sanction, the effect on a license or benefits, restitution, any ongoing monitoring or compliance obligations, whether the settlement is made public, its collateral consequences in other proceedings, and whether the matter can be resolved without admitting wrongdoing. The right settlement balances the certainty of resolution against the risks of a full proceeding, and that trade-off is different in every case.
Administrative and Criminal Standards of Proof
Administrative proceedings apply a lower standard of proof than criminal cases. Most administrative cases use the preponderance of the evidence standard (more likely than not), and some use a substantial evidence standard. A criminal case requires proof beyond a reasonable doubt. The lower administrative standard means a case can lead to license discipline or benefit termination on evidence that would never support a criminal conviction, which is why the administrative case has to be defended on its own terms even where there is no criminal exposure at all.
Effect on Reputation
An investigation affects reputation long before it produces a result. It can become public through agency announcements, court filings or media reports, and colleagues, employers, patients or clients may learn of it. Insurance carriers may be informed and adjust coverage, banking and credit relationships may be affected, and family relationships suffer under the stress. Careful handling of the case, public relations support where appropriate, and protective orders or sealing in some proceedings can limit these collateral effects.
Talk to Us
If you have received an investigation notice or a request for an interview, call us at 212-233-1233 or email [email protected] before you respond.
