In the current legal and investigative climate, the likelihood of a healthcare organization being contacted by law enforcement, government agencies, or other entities is substantial. This underscores the importance of maintaining compliance and readiness for potential inquiries. Organizations are advised to engage legal counsel and ensure their policies, procedures, protocols, and documentation are consistently updated to effectively respond if an investigation or audit occurs.
Organizational Policy as the Foundation for Response Planning
The creation of an organizational policy serves as the cornerstone of an effective response plan. By establishing clear policies, healthcare organizations lay the groundwork for consistent and well-structured actions when facing investigations or audits. This approach helps ensure that all protocols and procedures are aligned, providing a solid basis for training, compliance, and preparedness in the event of external inquiries. Before enacting any policy, ensure it is reviewed by legal counsel.
Best Practices for Handling Investigative Phone Inquiries
Phone inquiries relating to investigations require careful handling to safeguard organizational interests. When staff receive calls from individuals claiming to be investigators or representatives of an agency, they should follow a scripted response that includes verifying the caller’s identity and credentials. Staff should refrain from discussing details over the phone as the legitimacy of the inquiry has not been established and should immediately contact the person designated to handle investigative inquiries—such as a physician, office manager, or member of the legal department—for further guidance. These steps not only help identify potential scams but also ensure that sensitive information is protected and all communications align with organizational policies and applicable regulations.
Staff should remain aware of the potential fraudsters impersonating prosecutors, DEA agents, and other regulatory agencies. Please note these entities do not generally contact medical practitioners by telephone to request personal or sensitive information.1
Responding to Unannounced Law Enforcement Visits to a Clinical Practice
When law enforcement or other governmental agencies arrive at a physician’s office or ambulatory care setting requesting documents, seeking sensitive information, or serving legal papers, staff should verify their identification and credentials. Notify the designated organizational contact immediately to ensure all actions align with policy and regulations. Staff should document the encounter including names, affiliations, time, date, and any documents presented (e.g., warrants or subpoenas) but not share any information. Only designated personnel should communicate with investigators and provide materials as directed by legal counsel. This approach helps protect sensitive information, maintain compliance, and ensure a coordinated organizational response.
Detailed Steps for Handling Onsite Investigations
When investigators arrive onsite, staff should escort them to a separate room, away from patients and any areas where medical records are stored or accessible. This minimizes potential disruptions and protects sensitive information. Immediately contact the designated liaison within the organization and legal counsel to determine the appropriate level of access to grant the investigators.
Employees other than the designated liaison should refrain from responding to investigator requests; all responses to inquiries must be coordinated with legal counsel and adhere to organizational policy, ensuring that no unauthorized information is disclosed.
Verification and Documentation Steps
After credentials have been verified, legal counsel should be involved immediately to assess the validity and scope of the documents provided by the investigators. Documents such as search warrants or subpoenas, must be carefully reviewed.
The organization must ensure actions taken in response to the investigation comply with all applicable healthcare laws, including HIPAA regulations.2 For example, even with a subpoena, some mental health records require specific court orders before they can be disclosed.
In addition to organizational policies and federal guidelines, practices should remain attentive to any state-specific or local regulations that may influence the proper handling of law enforcement or agency investigations. These requirements can vary and may impose additional obligations or protocols. Staying current with all applicable local, state, and federal laws helps ensure comprehensive compliance and protects patient privacy, organizational interests, and staff when navigating unannounced visits or inquiries from officials.3,4
Conclusion
As regulatory oversight and enforcement evolve, physician practices should set clear protocols for handling law enforcement and agency inquiries and review them on a regular basis. They should align with current laws and specify steps like verifying investigators' identities, reviewing legal documents, and promptly involving legal counsel.
Regular policy reviews and staff training help maintain compliance. Open communication with legal counsel supports quick, consistent responses, reduces risk, and safeguards patient data during investigations.
If you are a ProAssurance insured and receive a suspicious inquiry you may contact Risk Management at 844-223-9648 or by email at RiskAdvisor@ProAssurance.com.
Endnotes
Drug Enforcement Administration, “DEA Warns Healthcare Workers of Impersonation Scam Targeting Doctors and Pharmacists,” October 24, 2024.
U.S. Department of Health and Human Services. “Health Information Privacy,” Last reviewed September 27, 2024.
U.S. Department of Health and Human Services, Office for Civil Rights, HIPAA Privacy Rule and Sharing Information Related to Mental Health. No publication date, accessed February 10, 2026. (PDF)
“Fraud and Abuse Laws,” U.S. Department of Health and Human Services Office of Inspector General. Accessed February 6, 2026.