An excerpt from Doctor Not Guilty.

The Fifth Amendment of the United States Constitution exists for a reason. It protects you from self-incrimination. If you remember one rule from this book, hold on to this: Never talk to the police.

By “police,” I mean every investigative agent: FBI, DEA, OIG, HHS, state boards of medicine, and investigators from the attorney general’s office. Not with a lawyer. Not without one. Not ever.

Silence by itself is not enough. In Salinas v. Texas, the Supreme Court ruled that prosecutors are allowed to use your silence against you if you do not clearly invoke your right to remain silent. So if an agent approaches you, you must speak one sentence: “I am invoking my Fifth Amendment right to remain silent and I want a lawyer.”

Anything less, and your silence turns into a weapon in their hands.

Look at Dr. Michael Bahrami, a cardiologist in Miami charged with conspiracy to commit health care fraud. Two colleagues had already pleaded guilty. The government had more than 30 video recordings from a cooperating witness. If the jury had convicted him, he would have gone to prison and lost his career.

Dr. Bahrami followed his lawyer’s advice. He did not sit for interviews. He did not give “clarifying statements.” He did not try to talk his way out. He held his silence and went to trial. The jury acquitted him. They found him not guilty. His silence protected him more than any explanation ever would have.

Now, look at Dr. Ajeeb John Titus, a family physician in Pennsylvania. A narcotics investigator walked into his office at the end of the day. The agent said, “You are not in trouble, Doctor. I have a few questions.”

Dr. Titus believed that truth would protect him. He agreed to a 45-minute interview. He answered every question. He tried to be helpful.

Two years later, he was arrested.

The indictment quoted his own words. Sentences pulled out of context. A late patient visit became a “drug deal after hours.” A charting shortcut became “intent to deceive.” The government did not need to guess what he thought. They had his words. His attempt to cooperate helped convict him. He lost his license and his practice.

Even highly trained people fall into this trap. Gen. Michael Flynn spent a lifetime in intelligence and interrogation. He believed he understood interviews with federal agents. He still ended up indicted for “false statements.” Not espionage. Not treason. Words. The interview became the crime.

Physicians sit in a special danger zone. We spend our days talking. We explain diagnoses. We teach. We reassure. We win people over with our voices. That skill serves us well in the clinic. At a table with federal agents, the same instinct destroys us.

In my own case, agents later testified that I made statements to them that I never made. They took a brief contact, in which I only gave them my lawyer’s name, and turned it into “incriminating comments.” There was no recording. There was only their memory and their report. Their version became “the record.”

So here is the rule of engagement for physicians. When an investigator appears, your job is not to educate them, reassure them, or clear anything up. Your job is to survive. You survive by invoking your rights and saying nothing.

Do not explain. Do not argue. Do not correct their misunderstandings. Do not try to be helpful. Say one sentence: “I am invoking my Fifth Amendment right to remain silent and I want a lawyer.” Then stop talking.

Silence is not arrogance. Silence is not guilt. Silence is governance. It is the only thing that stands between your life’s work and a report you will never see, written by someone who has already decided you are a problem to solve.

Five words protect everything you have built. Say nothing and save everything.

If you are a physician reading this, you likely feel a mix of anger and dread right now. You went into medicine to help people. You follow guidelines, fight with insurers, and work through exhaustion. You do not wake up planning fraud.

Yet the line between a “billing disagreement” and a felony charge has become thin and unpredictable. You see the stories. A colleague indicted over coding. A respected specialist marched out in handcuffs. An honest mistake treated as a scheme.

So what do you do after you say nothing?

You choose an attorney. And this choice might be the most important professional decision of your life.

How to choose an attorney when you are a doctor under fire

Do not hire the lawyer who handled your house closing or your divorce. Federal health care cases live in a different universe from everyday legal work. You need someone who breathes this world daily.

Look for real federal health care experience. Ask direct questions:

• How many health care fraud cases have you handled?
• How many went to trial?
• How many involved physicians?
• What sentences did the doctors receive?

Watch the answers. Watch the body language. A lawyer who tells you, “This will never reach trial, we will work it out,” is telling you more about their comfort level than about your risk. The government often stacks charges, uses complex guidelines, and pushes plea deals that feel like extortion. You need counsel who is willing to prepare for trial, even if trial never happens.

Ask who will stand next to you in court. Some firms send the partner to the first meeting for reassurance, then assign a junior lawyer to handle the real work. You deserve to know who writes your motions, who argues before the judge, and who stands with you when the jury walks in.

Pay attention to how they talk about you. Do they see you as a problem to manage, or as a professional whose life’s work is under attack? Do they understand coding, documentation, medical judgment, and the chaos of real practice? Or do they shrug and say, “The details do not matter; this is about negotiation.”

Finally, remember this: Your medical license is not your most important asset. Your judgment is.

Use it early.

When the agents come, say nothing. Then find an attorney who is not afraid of the words “Not guilty.”

I wrote Doctor Not Guilty because I lived this story. I stood in that courtroom. I heard the word “exonerated” after years of fear. I watched how close I came to losing everything I had built.

My plea to you is simple. Do not wait until the knock on the door. Learn the rules now. Talk to your family now. Know who you would call now.

Say nothing. Choose wisely.

Protect your life’s work before someone else writes your story for you.

Muhamad Aly Rifai is a nationally recognized psychiatrist, internist, and addiction medicine specialist based in the Greater Lehigh Valley, Pennsylvania. He is the founder, CEO, and chief medical officer of Blue Mountain Psychiatry, a leading multidisciplinary practice known for innovative approaches to mental health, addiction treatment, and integrated care. Dr. Rifai currently holds the prestigious Lehigh Valley Endowed Chair of Addiction Medicine, reflecting his leadership in advancing evidence-based treatments for substance use disorders.

Board-certified in psychiatry, internal medicine, addiction medicine, and consultation-liaison (psychosomatic) psychiatry, Dr. Rifai is a fellow of the American College of Physicians (FACP), the American Psychiatric Association (FAPA), and the Academy of Consultation-Liaison Psychiatry (FACLP). He is also a former president of the Lehigh Valley Psychiatric Society, where he championed access to community-based psychiatric care and physician advocacy.

A thought leader in telepsychiatry, ketamine treatment, and the intersection of medicine and mental health, Dr. Rifai frequently writes and speaks on physician justice, federal health care policy, and the ethical use of digital psychiatry.

You can learn more about Dr. Rifai through his Wikipedia page, connect with him on LinkedIn, X (formerly Twitter), Facebook, or subscribe to his YouTube channel. His podcast, The Virtual Psychiatrist, offers deeper insights into topics at the intersection of mental health and medicine. Explore all of Dr. Rifai’s platforms and resources via his Linktree.