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.
Editors Note: This article was originally published on ICD10monitor, April 15, 2025 In a sweeping policy shift, the Centers for Medicare & Medicaid Services (CMS)
In just days, the U.S. Department of Health and Human Services (HHS) may begin eliminating regulations it deems unlawful or beyond its authority – that
Please log in to your account to comment on this article.
Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s fourth quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s third quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s second quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Struggling with CMS’s 3-Day Payment Window? Join compliance expert Michael G. Calahan, PA, MBA, CCO, to master billing restrictions for pre-admission and inter-facility services. Learn how to avoid audit risks, optimize revenue cycle workflows, and ensure compliance across departments. Critical for C-suite leaders, providers, coders, revenue cycle teams, and compliance teams—this webcast delivers actionable strategies to protect reimbursements and meet federal regulations.
Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.
Copyright © 2025 ICD10monitor. Powered by MedLearn Media.
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. 2 with code CYBER24
