Feds of a Feather Investigate Together

Much like episodes of Law & Order, news stories often provide the ideas for my articles. Events off the East Coast last week offered a quick reminder about the importance of recognizing the significance of contacts with certain government investigators. 

Last week, former presidential advisor Steve Bannon was arrested on a yacht off the coast of Connecticut. Since the arrest happened on a boat, it’s not surprising that the Coast Guard was involved. But who else was involved in the arrest? This may be surprising, but it wasn’t the FBI. Instead, postal inspectors joined the Coast Guard.   

While you may think of the U.S. Postal Service primarily for moving the mail, postal inspectors often spearhead mail and wire fraud investigations. If you’re ever visited by a postal inspector, it’s a big deal. And postal inspectors aren’t the only government agents whose titles may be misleadingly innocent-sounding. A wide range of government agents lack the cache and pop culture appeal of FBI agents, but their impact can be just as significant. 

Agents from the U.S. Railroad Retirement Board or the Defense Criminal Investigative Service (DCIS) commonly appear in healthcare fraud investigations. At least DCIS has “criminal” in its name, making their legal clout a bit more obvious. One might think the Railroad Retirement Board is responsible for saving people tied to the tracks in some cartoon caper. In fact, they help the government bring criminal charges for healthcare insurance fraud. 

Perhaps you have heard references to “MFCUs.”  Both the acronym and its pronunciation (“Mafookoos”) might sound like they belong in a dirty joke, but these State Medicaid Fraud Control Units have the ability to conduct criminal investigations. It’s not all that unusual to see agents from the Food and Drug Administration (FDA), Drug Enforcement Administration (DEA), or, in rare instances, the Nuclear Regulatory Commission pop up in a healthcare fraud investigation. 

The main lesson is any time you see an agent from any government agency appear in an investigation, assume that it is a very big deal.

Most insurance companies have fraud units staffed by people with titles not unlike the government agents. While these “special agents” or “fraud investigators” from private companies can’t directly lock you up, don’t be too quick to dismiss them. It’s not uncommon for private insurers to work hand in hand with government agents. I’ve seen private insurance companies turn over entire files to government investigators. In one case, the insurance company sent undercover patients who recorded their interactions with a surgeon and then turned over the videos to the government. 

The bottom line is that you don’t want to underestimate the power of lesser-known government agencies. While they may not appear in as many TV shows, they can definitely get you in the headlines. 

Programming Note: David Glaser is a permanent panelist on Monitor Mondays. Listen to his live reporting every Monday at 10-10:30 a.m. EST.

Facebook
Twitter
LinkedIn

David M. Glaser, Esq.

David M. Glaser is a shareholder in Fredrikson & Byron's Health Law Group. David assists clinics, hospitals, and other health care entities negotiate the maze of healthcare regulations, providing advice about risk management, reimbursement, and business planning issues. He has considerable experience in healthcare regulation and litigation, including compliance, criminal and civil fraud investigations, and reimbursement disputes. David's goal is to explain the government's enforcement position, and to analyze whether this position is supported by the law or represents government overreaching. David is a member of the RACmonitor editorial board and is a popular guest on Monitor Mondays.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Mastering Principal Diagnosis: Coding Precision, Medical Necessity, and Quality Impact

Mastering Principal Diagnosis: Coding Precision, Medical Necessity, and Quality Impact

Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.

December 3, 2025

Proactive Denial Management: Data-Driven Strategies to Prevent Revenue Loss

Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.

November 25, 2025
Sepsis: Bridging the Clinical Documentation and Coding Gap to Reduce Denials

Sepsis: Bridging the Clinical Documentation and Coding Gap to Reduce Denials

Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.

September 24, 2025

Trending News

Featured Webcasts

AI in Claims Auditing: Turning Compliance Risks into Defensible Systems

As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.

January 13, 2026
Surviving Federal Audits for Inpatient Rehab Facility Services

Surviving Federal Audits for Inpatient Rehab Facility Services

Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.

November 13, 2025
E/M Services Under Intensive Federal Scrutiny: Navigating Split/Shared, Incident-to & Critical Care Compliance in 2025-2026

E/M Services Under Intensive Federal Scrutiny: Navigating Split/Shared, Incident-to & Critical Care Compliance in 2025-2026

During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.

August 26, 2025

Trending News

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24