Decisions by the Supreme Court provide compelling reasons for employers to perform investigations.  A good investigation can protect your organization, while a bad one can become an employee relations fiasco.  If companies follow the proper process, companies should end up making the “right” decision. Typically, “routine” internal investigations focus on day-to-day matters: Accounting fraud Theft of physical assets Unauthorized access to data (manipulation or sale)...

This is the first of four postings on internal investigations.  The focus of these postings is not the high-profile internal investigations which are regularly disclosed to the SEC or reported in the press.  Instead, I am focusing on “routine” or day-to-day internal investigations which are conducted to handle a variety of issues.  The art of day-to-day internal investigations has been ignored in favor of media...

Healthcare fraudsters do not discriminate between private and public medical insurance.  Fraudsters use similar schemes to defraud Medicare and Medicaid and private insurance companies.  Most healthcare providers bill public and private payers.  For example, a health care provider may be billing Medicare, Medicaid and several private health plans (in-network and out-of-network).  Private insurance companies also provide insurance as Medicare Parts C and D contractors or...

I find the so-called “vampire” cultural phenomena scary – I do not understand what is so entertaining about “ordinary” people who can suddenly turn into vampires, let alone enter into “serious” relationships with each other or with so-called “normal” humans. Maybe I am stuck in the past when “Night of the Living Dead” was more my cup of tea.  Whatever your attitude toward death and...

The Justice Department and the Department of Health and Human Services have made healthcare fraud a number one priority – it is another example of the synergy of politics and enforcement.  Congress spends more money on prosecution resources and prosecutors use these resources to bring more criminal and civil enforcement actions.   Every few months the government announces another nationwide crackdown and defendants are swept up...

Companies face a lot of risks these days in this enforcement environment.  With the reelection of President Obama, businesses need to plan for four more years of continuing enforcement risks.  While everyone appears to be spending time on FCPA enforcement and compliance, companies need to spend more time in protecting themselves from the False Claim Act.  The government uses the False Claims Act to recover...

The Financial Crimes Enforcement Network (FinCEN) is a new, imposing figure in the world of financial regulatory enforcement.  As originally created, FinCEN served as an information and intelligence support system for other regulatory agencies and federal prosecutors.  That all changed in 2004 when Congress mandated that FinCEN create an Office of Compliance.  Since then, FinCEN’s importance as a regulatory and enforcement agency has grown. The...