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Investigating health care fraud through CID
Last Updated on: 15th March 2025, 10:59 pm
INVESTIGATING HEALTH CARE FRAUD THROUGH CID
If you’re on our website right now, it’s likely because you or someone you care about received a document that was delivered from the government. That document, which is typically called a Civil Investigative Demand (CID), can open the door to a massive investigation. It’s serious. You need a top rated lawyer. You need someone who has experience dealing with federal investigations. At Spodek Law Group, we get it, and we’re here to help you understand your rights, possible penalties, and how to fight back.
Here’s my take: A CID that was issued under the False Claims Act can ruin your life. The government, which includes agencies like the Department of Justice (DOJ) and the Office of Inspector General (OIG), is dead serious about health care fraud. If you think ignoring that CID is an option, you’re playing with fire. That can lead to steep financial penalties or even time in prison. When you refuse to respond, you look like you’re hiding something, and that can make prosecutors double down. They’ll go after you harder. One key reason is that ignoring official demands usually signals guilt in the eyes of investigators.
So, let me be direct: If you’re making excuses right now, stop. You’re worried. You’re embarrassed. But guess what? Worry and embarrassment won’t fix a federal investigation. You need an approach that was developed to prevent the worst-case scenario: federal charges that lead to a conviction. We are Spodek Law Group, a nationwide federal defense law firm created by Todd Spodek. Our attorneys have over 50 years of combined experience, representing clients in investigations nationwide. And we see the same avoidance tactics again and again: “I’ll just wait and see what happens,” or “I’m sure it’ll blow over.” I’m telling you now—it won’t, and it’s time for you to take it seriously.
WHAT IS A CIVIL INVESTIGATIVE DEMAND?
A Civil Investigative Demand, or CID, is a tool federal authorities use when they suspect a company or person of violating the law, particularly the False Claims Act. The False Claims Act is the law that was designed to punish anyone who tries to scam government programs, such as Medicare or Medicaid. When the government thinks you’ve submitted false bills, or inflated charges, or done anything else that seems shady, they might serve you with a CID. A CID that was served on your business requires you to produce documents, answer questions, or even give testimony. That’s not a request you can ignore. If you ignore it, you risk an even harsher crackdown and bigger punishments from the DOJ.
When you’re served a CID, the government is effectively saying: “We have reason to believe you broke the law, and we want evidence.” This means your entire practice could be taken from you. You could face significant financial penalties, a permanent record of fraud, or even prison time. Your reputation and livelihood are at stake. If you’re a medical professional who was accused of inflating bills, or a practice manager who was suspected of double-billing, this is a threat to everything you’ve built. That’s the consequence of health care fraud allegations. Your reputation might be destroyed, patients may lose trust in you, and you might lose your professional license. That’s how real it gets.
COMMON HEALTH CARE FRAUD SCHEMES
Health care fraud can happen in many ways. It’s not always a matter of “evil doctors” scheming. Sometimes staff members who were poorly trained make mistakes, or your practice sets up billing software that was designed incorrectly. But the government doesn’t always see the difference between an innocent mistake and a deliberate scam. Because of that, you can still end up facing serious charges for errors. Here are some common schemes:
- Double billing that was spotted in Medicare submissions can trigger a CID
- Phantom patients that were listed on claims can raise a red flag
- Billing for services that were never provided can draw major scrutiny
- Upcoding (charging for higher-level services than what actually took place)
All of these can result in the government taking swift action. The consequence is that you might face huge fines, lose your practice, or even face criminal charges. Federal prosecutors may also freeze assets or claw back past Medicare or Medicaid payments. A single fraudulent claim can snowball into an all-out legal battle if you don’t respond properly to a CID.
PENALTIES AND POTENTIAL CRIMES
Under the False Claims Act, each false claim can rack up a penalty that is calculated per violation. You could be looking at fines of over $10,000 per claim, plus triple damages. That means if the government proves you billed an extra $500,000 worth of false charges, they could come after you for up to $1.5 million or more. The real kicker is that if prosecutors believe you acted “knowingly,” you could also face criminal fraud charges. A criminal case can lead to time in federal prison. Intent is one of the biggest and most important components of a crime; the prosecutor has to prove you knowingly did it.
If you think you can talk your way out of it, you’re betting against a system that was designed to punish health care fraud aggressively. The Centers for Medicare & Medicaid Services (CMS) and HHS OIG conduct regular audits, and they share information with the DOJ. That means once you’re on their radar, you won’t be off it anytime soon, especially if you fail to respond to the CID or produce incomplete information. The consequence is that you become an even bigger target for potential enforcement.
Here’s a truth: the government wants to make an example out of people who commit health care fraud. That’s because medical programs like Medicare need to protect billions of dollars from misuse. They see you as a potential offender, and if they prove it, they’ll use your case as a tale. That’s the real-world consequence: your case might become the next big headline about a practice that was raided and bankrupted by the DOJ. The best way to avoid that outcome is to create a strategic defense strategy now.
HOW WE DEFEND YOU
At Spodek Law Group, we’ve been down this road. We understand that health care fraud investigations can be confusing, terrifying, and life-altering. Our approach is harsh. First, we take a long, honest look. Then we call out anything that looks like a mistake, half-truth, or lack of preparation. We don’t tolerate excuses. We care about you, but we’re not here to sugarcoat reality. We tell you the hard truth: either we handle this proactively, or you risk major penalties and possible jail time.
We start by analyzing the CID that was served on you. We look at the scope of the demands, the deadlines, and the specific documents or testimony requested. Then we build your legal strategy. That often means collecting all relevant records, lining up any witnesses who were involved, and creating a narrative that was carefully crafted to show the government the real situation. If there was no criminal intent and mistakes happened due to software errors or staff confusion, we make that very clear. If the government’s evidence is not good or strong, we fight to get the CID narrowed or dismissed. When evidence that was illegally obtained might be introduced, we argue it should be thrown out. This outcome is critical because any evidence that’s declared inadmissible can weaken the prosecution’s case and make it more likely they’ll reduce or dismiss charges.
We also use a system-based defense strategy. We identify the root causes of any irregularities in billing, whether it was a mistake or not. For instance, if you relied on an outside vendor who was incompetent, that factor can change the nature of your liability – this is a mistake, not a crime. The consequence is that the prosecutor’s angle of “knowing fraud” might be undermined. We gather evidence that was relevant to show no intent to defraud. If we believe settlement is your best option, we’ll negotiate fiercely to protect your practice and reduce fines.
LEVERAGE AND MAXIMUM IMPACT
At our core, we believe in finding leverage points that give our clients maximum impact. A CID can feel like the end of the world, but it can also be a chance to resolve issues before they blow up into a full-blown criminal case. If the prosecution sees that we respond quickly, produce the right documents, and have a solid explanation, there’s a better chance they’ll work with us. The flip side is that if you act slowly or try to hide anything, they’ll assume the worst.
Here’s where we will be brutally honest: some professionals panic and try to shred records or mislead investigators. That move can bring you closer to criminal obstruction charges, which is a game-changer. Once obstruction allegations enter the picture, prison time is squarely on the table. We don’t want that for you. We’re telling you now that such a move is reckless and can ruin your life. The best plan is a direct, strategic response. With a well-executed defense, you can minimize risk and possibly keep your practice going without destroying your reputation. That’s the outcome you want. That’s what we fight for every single day.
THINK BIGGER, THINK BOLDER
You don’t have to do this alone. We are available 24/7. If you choose not to reach out, you choose to put yourself at the mercy of a federal system that was built to protect government funds at all costs. The consequence of that choice is likely huge fines, a broken reputation, and a potential criminal record. You don’t want that, and we don’t want it for you. Contact us now. Let’s get to work.
Disclaimer: The information in this article is not intended to be legal advice nor does reading it create an attorney-client relationship. Every case is different, and you should seek a formal consultation with a qualified attorney licensed in your state.
We are Spodek Law Group, a nationwide federal defense law firm founded by Todd Spodek. We represent clients in major federal investigations. We know what it takes to protect you. Call us or reach out today for a risk free consultation. Let’s tackle this head-on, before the government’s investigation gets out of hand.