Most of my clients don’t call me because things are going well. No one rings up their health care audit lawyer just to say, “Hey, just wanted you to know I’m thriving!”
No, they call because they’ve received The Letter. The dreaded post-payment audit letter that says, in so many bureaucratic words: “Hi there, you owe the government a Gaga billion dollars. Pay up or buckle up.”
But recently, something miraculous happened. A provider hired me before they got The Letter. That’s right—before the panic attack, before the calculator came out, before the search history turned to “Can I sell a kidney on eBay?”
They hired me when they received the initial request for records. You know, the one that most folks ignore until it metastasizes into a financial horror story. Naturally, I was intrigued. Would the auditing contractor still find the usual catastrophic error rate and slap us with a bill that could fund a small country? Or… would sending the records on snazzy law firm letterhead make a difference?
Now, I’ve been doing this a long time. Long enough to know that nobody hires me after a clean audit, because nobody gets a clean audit. At least, not in my inbox. My audit world is like a medical drama—every case has complications. So, my perspective might be skewed.
I mean, how would I know how many providers get audit results that say “0 dollars owed”? Those people are off living their best lives, not calling me in a cold sweat.
But this time, I got a front-row seat before the fireworks. I reviewed the records. They were solid. Not valedictorian-of-documentation solid, but at least in the National Honor Society. Honestly, they looked like pretty standard stuff—very similar to what I’ve seen from clients who’ve gotten slapped with Gaga billion-dollar letters.
So we submitted. On law firm letterhead. We waited.
And then… it happened.
We got the results. I braced myself.
It said: “100% accurate. No overpayment.”
Reader, I nearly fainted. I had to reread it three times. I’ve never seen a zero from an auditor without at least three commas behind it. I stared at that “0” like it was a unicorn riding a hoverboard. I considered framing it. Gold leaf, shadowbox, the whole deal.
But it left me with questions. Did my client dodge a Gaga bill because the documents were exceptional? Or was the magic in the Nelson Mullins letterhead?
You decide.
Meanwhile, in the Magical Land of FCA Enforcement…
Back in September 2024, Walgreens found itself writing a $106.8 million thank-you card to the Department of Justice for accusing it of submitting false claims to federal health programs.
Its sin? Billing Medicare, Medicaid, and friends for prescriptions that patients never picked up—between 2009 and 2020. Walgreens, to their credit, found the issue (thanks, software glitch), self-reported it, gave back $66.3 million like a responsible adult, and implemented changes to make sure it wouldn’t happen again.
The DOJ, however, said: “Cool story. Pay us anyway.”
This raises the question: Is the False Claims Act a tool to punish fraud, or a cosmic test of a company’s patience and treasury? Critics say this case is a poster child for overreach—where good-faith efforts to self-correct don’t matter once Uncle Sam gets wind of potential cash.
Oh, and don’t forget the whistleblowers—former employees who flagged the issue. They got a cut of the settlement. Which is great in real fraud cases, but maybe a bit counterproductive in situations where a company voluntarily admits to a mistake. If this is how we treat self-reporters, why would any company ever come clean again?
Speaking of punishment, FCA penalties went up by $1,000 this year. Doesn’t sound like much, right?
Well, multiply $1,000 by 10,000 false claims. (That’s 10 million, right? I was an English major, don’t @ me.)
In the FCA world, a thousand bucks is the equivalent of turning up the volume from “mild inconvenience” to “bankruptcy with a side of despair.”