How to Respond to a Records Request from CMS or the OIG

For healthcare providers, receiving a records request from the Centers for Medicare & Medicaid Services (CMS), the Office of Inspector General (OIG), or one of their contractors can be an alarming experience. Whether the request arrives through a Medicare audit, a Medi-Cal investigation, a program integrity review, or a fraud inquiry, providers often find themselves facing significant uncertainty about what the request means and how they should respond.

A records request should never be viewed as a routine administrative matter. While some requests are part of standard oversight activities, others may be connected to allegations of billing errors, overpayments, documentation deficiencies, or suspected fraud. The manner in which a provider responds can have a substantial impact on the outcome of the audit or investigation.

The Law Offices of Art Kalantar in Beverly Hills represents healthcare providers throughout California in Medicare and Medi-Cal audits, investigations, overpayment disputes, fraud allegations, and healthcare criminal defense matters. Our firm guides clients through every stage of the process—from the initial records request to final resolution—helping them protect their practices, licenses, and reputations.

Understanding Why CMS or the OIG Is Requesting Records

Healthcare providers may receive records requests from several different entities acting on behalf of CMS or the OIG. These requests often arise from audits conducted by Unified Program Integrity Contractors (UPICs), Recovery Audit Contractors (RACs), Supplemental Medical Review Contractors (SMRCs), Medicaid Integrity Contractors (MICs), or other government contractors.

The purpose of the request may vary. In some cases, auditors are reviewing claims for documentation compliance or medical necessity. In others, investigators may be evaluating billing practices, referral relationships, or potential fraud indicators. A request for records does not necessarily mean wrongdoing has occurred, but it should always be treated seriously.

One of the first objectives is determining who is requesting the records, what claims are being reviewed, and whether the matter appears to be a routine audit or part of a broader investigation.

Avoid the Mistake of Responding Without Legal Guidance

Many providers make the mistake of immediately gathering records and sending them to the requesting agency without first consulting counsel. While cooperation is important, an unstructured response can create unnecessary risks. Healthcare records requests often involve complex regulatory issues. Missing documents, incomplete submissions, inconsistent records, or unnecessary disclosures can all complicate the matter. In some situations, information provided during the audit may later be used in civil enforcement actions or criminal investigations.

An experienced healthcare defense attorney can review the request, evaluate potential exposure, and help develop a response strategy that protects the provider’s interests while ensuring compliance with legal obligations.

Preserve and Review All Relevant Records

Once a records request is received, providers should immediately preserve all relevant documentation. This includes patient records, billing records, internal communications, policies, and any other materials related to the claims under review. Providers should never alter, revise, or recreate records after learning of an audit or investigation. Even well-intentioned efforts to clarify documentation can be misconstrued as attempts to conceal information or modify evidence. Instead, records should be carefully reviewed to identify any issues that may require legal analysis before submission. This review process often reveals documentation gaps, coding concerns, or other matters that should be addressed strategically.

Produce Records Carefully and Completely

Government agencies expect providers to comply with records requests fully and within the specified deadline. However, compliance does not mean providing every document in the provider’s possession. One of the most important aspects of responding to a records request is ensuring that production is complete, organized, and limited to what has actually been requested. Producing irrelevant materials can unnecessarily expand the scope of the audit and expose additional areas of inquiry. The Law Offices of Art Kalantar works closely with clients to manage document collection and production, helping ensure that responses are accurate, organized, and strategically prepared.

Understand That Audits Can Escalate

Many healthcare providers assume that a records request is simply a documentation review. Unfortunately, audits frequently evolve into more serious matters. Auditors who identify billing irregularities, documentation deficiencies, or unusual utilization patterns may refer cases for further investigation. In some situations, matters are escalated to the OIG, the Department of Justice, the FBI, or the California Department of Justice. What begins as a request for patient records can ultimately result in repayment demands, False Claims Act allegations, exclusion proceedings, or criminal fraud investigations. This reality makes early legal involvement particularly important. Providers should approach every records request with the understanding that it may be reviewed by multiple agencies and investigators.

Responding to Follow-Up Requests and Interviews

Records production is often only the beginning of the process. Auditors may request additional records, written explanations, or interviews with providers and staff. These interactions require careful preparation. Statements made during interviews or written responses can significantly influence how investigators view the case. Even truthful statements may be misunderstood or taken out of context if they are made without proper preparation. The Law Offices of Art Kalantar assists clients with all aspects of the audit process, including communications with government agencies, preparation for interviews, responses to follow-up inquiries, and strategic defense planning.

Challenging Audit Findings

If auditors determine that overpayments occurred or identify alleged compliance violations, providers are not required to simply accept those findings. Many audit determinations are based on disputed coding interpretations, documentation standards, medical necessity assessments, or statistical extrapolations. Providers often have significant legal and factual defenses available. Our firm represents healthcare providers throughout the appeals process, challenging improper findings, contesting extrapolated damages, and advocating for fair outcomes. We work to minimize financial exposure while protecting our clients from unnecessary escalation.

Comprehensive Representation from Start to Finish

Healthcare audits and investigations rarely end with a single records request. Providers often face a series of document demands, interviews, findings letters, appeals, and, in some cases, enforcement actions. The Law Offices of Art Kalantar provides comprehensive representation throughout the entire process. We assist providers from the moment an audit notice or records request arrives, guiding them through document production, communications with investigators, audit defense, appeals, overpayment disputes, civil fraud matters, and healthcare criminal defense when necessary. Our goal is not simply to respond to a records request. Our goal is to protect the provider, preserve the practice, and minimize legal and financial exposure at every stage of the matter.

Contact the Law Offices of Art Kalantar in Beverly Hills

If your California medical practice has received a records request from CMS, the OIG, a Medicare contractor, or a Medi-Cal investigative agency, it is important to seek experienced legal guidance as early as possible. The Law Offices of Art Kalantar has represented healthcare providers in audits, investigations, fraud matters, and healthcare criminal defense cases for more than two decades. We provide strategic counsel and vigorous representation from the first records request through final resolution, helping providers navigate one of the most challenging situations they may face. Contact us today for practical advice and a strategic response.