Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!

Nationally recognized psychiatrist, internist, and addiction medicine specialist Muhamad Aly Rifai discusses his article “Physician legal rights: What to do when agents knock.” Muhamad shares a terrifying but essential guide for any doctor facing an unexpected visit from federal agents or investigators. He explains why the physician’s natural instinct to educate, reassure, and be helpful is actually a liability that can lead to a prison sentence. The conversation highlights the critical legal distinction established in Salinas v. Texas which means silence alone is not enough to protect you without a verbal invocation of rights. Muhamad contrasts real-life case studies of doctors who talked and lost everything with those who remained silent and were exonerated. Learn why the only safe response to an investigator is a specific single sentence that invokes your Fifth Amendment protection.

Partner with me on the KevinMD platform. With over three million monthly readers and half a million social media followers, I give you direct access to the doctors and patients who matter most. Whether you need a sponsored article, email campaign, video interview, or a spot right here on the podcast, I offer the trusted space your brand deserves to be heard. Let’s work together to tell your story.

PARTNER WITH KEVINMD → https://kevinmd.com/influencer

SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended

Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Muhamad Aly Rifai, internist, psychiatrist, and addiction medicine specialist. Today’s KevinMD article is an excerpt from his book titled Doctor Not Guilty. The excerpt is titled “Physician legal rights: what to do when agents knock.” Muhamad, welcome back to the show.

Muhamad Aly Rifai: Thank you very much for having me to talk a little bit about my book, Doctor Not Guilty, and some of the lessons that I learned from my experience facing a prosecution for health care fraud by the federal government. I want to share some of the advice that I can provide to fellow physicians in terms of interactions with law enforcement, investigative agencies, and state boards. This is something that they really need to keep in mind in this litigious world that we live in.

Kevin Pho: All right. And I know you have shared your story in prior episodes, but for those who are not familiar with your story, just give us a little bit of context. Briefly tell us what happened to you.

Muhamad Aly Rifai: In 2017, I faced an investigation by the federal government. In 2022, I was indicted on four charges of health care fraud mostly stemming from telehealth, telemedicine, and telepsychiatry services that I provided to elderly individuals in rural Pennsylvania. The argument from the federal government was that the services that I provided were just medication checks and there was no talking with the patient or no psychotherapy.

I decided to go to trial. After a six-day trial, the jury came back in two hours and found me not guilty on all charges. That led me to write my book, which is Doctor Not Guilty, where I talk about my experience. It is a memoir about my experience going through a federal criminal prosecution.

I also tell the stories of other physicians who faced similar circumstances being prosecuted by the federal government and the course of what happened to them. I provide some guidance not as an attorney but as a fellow physician on how to deal with such circumstances in this kind of litigious society and the court system. I tell people exactly what I learned from this experience and how they can stay on the positive side of the law.

Kevin Pho: Now, in the midst of this entire story, how did you know to do what you did? Where did you get advice from? Because I could only imagine as you were going through the process, it is not like you had any training in this. How did you know what to do and how did you know what you did was right?

Muhamad Aly Rifai: I had an interest in the law. I think I was lucky because I had an interest in the law for the 15 years prior to this investigation starting. I was actually a psychiatric expert witness and I testified in court on many occasions for cases that even involved the death penalty. I was actually an expert witness in two cases that were involving the death penalty. So I was very well involved and very well versed in the legal field.

I think that helped me a lot. I tried to see if I could import or transmit some of that knowledge that I gained through my legal involvement as an expert witness. I think that helped me a lot to have that knowledge and be a model defendant who was able to do everything by the book and in the right way. I did not fall into any of the pitfalls of the legal system because the legal system is unforgiving. If somebody does not know the rules, basically they will suffer negative consequences.

Kevin Pho: So talk to us more about this article in your book. What are some things physicians should and should not do should they find themselves in this situation?

Muhamad Aly Rifai: I tell people in the book that if anybody is going to come away with one message from my book, that should be to never talk to the police. By the police, I mean investigators. I mean government investigators, Board of Medicine investigators, police, FBI, Office of Inspector General, Department of Health and Human Services, and the Drug Enforcement Agency. All of these law enforcement officials may interact or come in contact with physicians and may ask physicians to talk to them or may ask physicians to sign papers.

The Fifth Amendment of the United States Constitution exists for a reason. It is to protect you from self-incrimination. Self-incrimination means basically you may have done nothing wrong, but providing any statement could be construed in a negative way. We are physicians. So in our training, we are trained to talk to people. We are trained to try to convince people to do something, such as take their medications or have a diet. So we are basically people pleasers.

What happens is basically physicians will start talking to law enforcement officers, police, FBI, Office of Inspector General, or state board investigators and start offering information. Most of the time these interviews are never recorded. Basically, it is your version versus the officers who are there who write their own version of events. What ends up happening is you provide statements that are not going to be helpful for you regardless of what you think that you are providing.

My only advice is never talk to the police. If they come to you and want to talk to you, the professional thing to do is to say: “I hear you. I understand you want to talk to me, but I want to discuss this with my attorney. I do not want to speak with you. I invoke my Fifth Amendment rights.” You really have to verbalize that and say: “I would like to talk to my attorney.”

Let anything that you submit to the government or to investigators be through your attorney. Do not do it through you or through any statements that you make because anything that you make, any statements that you make, or any papers you submit are all things that are going to be used against you. It is not that they *would* be against you. They *are* going to be used against you. They are going to be misconstrued and used against you. So providing no statements is best. Even if in the future there is a decision that something wrong was done and you want to provide a statement, let that be through your attorney, not with anything that you say.

Kevin Pho: What would be an example of something that would be seemingly innocuous that you would disclose to the authorities that could be used against a physician? What would be just an example of that?

Muhamad Aly Rifai: For example, I give a story of a local family physician who basically talked to government investigators. He told them that he met up with a patient and the patient was delayed and needed his medication. The patient was a chronic pain patient who needed opiates but he was being prescribed appropriately. He told them that he waited for the patient to come after hours because he was delayed with traffic.

That was construed as meaning that this physician was diverting controlled substances after hours to patients. Basically, that was the headline that was construed. The physician actually had no recourse toward that. He actually had to plead guilty for drug diversion even though what he did was legal and appropriate. There was no diversion, but only that statement that he gave to investigators that he waited until after hours became evidence that he was diverting controlled substances to patients after hours.

Kevin Pho: Now you see in the movies that the authorities can use a variety of tactics to get you to talk to them. So give us an example. Is it like the movies? What are some of the techniques that authorities can use to get you to talk to them without your attorney present?

Muhamad Aly Rifai: They will say: “Doctor, we are Agent So-and-So and we are here from the government. We just have a few questions. We are hoping that you can clear these things up for us. There is nothing against you. You are not in any danger. There are no charges against you or anything like that. We just have a few questions for you. Maybe you can clarify things for us.”

Basically, that is the slippery slope. They lull you into comfort that you are not under an investigation. The police are allowed to lie to you. They tell you that you are not under any investigation and everything is clear. They just need to clarify things. Basically, that is the beginning of the end for you because once you start talking, all of the information is going to be misconstrued and taken against you.

In my book, I actually tell the story of a very famous person. He was a national security advisor for the president. His name is General Michael Flynn. For those who do not know him, he was the head of military intelligence. His job was to interrogate Al-Qaeda people and basically to break them and get information from them. Even he was lulled into comfort because the FBI, when he was National Security Advisor, came to the White House and they interviewed him and used the same tricks. They said: “General Flynn, we just have a few questions for you.”

Basically, they did not get him on any illegal issues. They just got him on making false statements to the authority. Basically, if he says something that he did not remember right, and there was documentation, for example, that he was somewhere at one time and he said he was there at a different time, that is a false statement to the federal investigators. That by itself is a crime. So they never got him on anything else. They just got him on making a false statement. So I tell physicians that if they got General Michael Flynn, you should not talk to police or investigators at any time.

Kevin Pho: So just to be clear, even if the authorities come to you and say you are not under any investigation or under any suspicion, that can certainly change going forward, right? Is that what you are saying?

Muhamad Aly Rifai: Absolutely. You could make a statement and then you become under investigation and you have no protection of anything. We have seen that even sometimes when you provide a statement even through your lawyer, if the government thinks that statement is false, they could charge you with making false statements even through your lawyer.

A senator who was indicted and is actually now in jail, Senator Menendez, submitted some information to the government trying to clear himself. Even then the government charged him with submitting false statements even through his lawyer because they perceived that he was trying to give them false statements. So it is very important to discuss everything with the lawyer before providing any statements. That is professionalism.

Always be very courteous. There is no need to be inappropriate. Just be very courteous and say: “Officer, I understand you are doing an investigation. I really want to cooperate. You are going to get my full cooperation, but I want to do this cooperation through my attorney. I invoke my Fifth Amendment rights. I am going to discuss this with my attorney and we will get back to you.”

So you do the interview on your own time and in your own comfort after you studied exactly what is being investigated. If there is going to be an interview or you are going to provide any information to the police or the authorities, do it that way. Sometimes that upsets the officers because their impression is that they want to talk to you and get it over with and get things done and move on with this investigation. But you need to protect your rights. So always talk only with your attorney and never talk to the police alone.

Kevin Pho: So let’s talk about next steps. You said do not talk to the authorities, invoke your Fifth Amendment rights, then call your attorney. What kind of attorney should you call?

Muhamad Aly Rifai: I actually give multiple talks about that. It is very important to choose an appropriate attorney. You do not want the attorney, for example, that writes your will. You do not want the attorney that basically reviews your contract whenever there is an investigator coming to you. One exception is if there is an investigator coming from, for example, the Board of Medicine.

You really want a specialist. You want somebody who specializes exactly with the type of problem that is being investigated. So if you get criminal investigators, you really need a criminal defense attorney. For example, if it is federal or if it is state, get a federal criminal defense attorney or a state criminal defense attorney. If it is a board investigation, you really need somebody who is very well attuned to board issues. In every field, there are specialists. So you really need to take your time and decide on basically the appropriate attorney that is going to address this.

Also seek help. For example, because of my experience, I started a service called SHIELD: Support and Help in Ethical Legal Defense. Basically, I provide advice to other physicians who are facing issues and tell them: “Listen, I will help you. I will give you maybe the names of three or four different attorneys that you can interview and be able to decide which attorney do you want to retain.” Specialization is very important. Like in medicine, in law there are specialist attorneys who handle these issues that are pertinent to physicians. There are specialty law firms that only cater to physicians.

Kevin Pho: Physicians, understandably, would be terrified if this happened to them. With no training, authorities coming at them, sometimes they may think that staying quiet makes them look guilty. How do you counsel physicians who think that way?

Muhamad Aly Rifai: Basically being quiet is your savior because if something is going to happen and you want to be able to convey your side, let this happen in court. Let this happen in a deposition where it is controlled, where you have your attorney, and where you are able to figure out exactly what you are saying and figure out exactly what is being investigated.

That is why I tell physicians: “Listen, hold any statement that you are going to make and make sure that it is made with an attorney at the right time.” Because if you make any statements prematurely, basically it is going to be used against you. So always save all statements. Staying silent is going to be something that saves you. It is not going to make you look guilty at all. Always invoke your Fifth Amendment rights. Always invoke your right to have an attorney present.

Kevin Pho: We are talking to Muhamad Aly Rifai about his book, Doctor Not Guilty. That KevinMD excerpt is “Physician legal rights: what to do when agents knock.” Muhamad, let’s end with take-home messages that you want to leave with the KevinMD audience.

Muhamad Aly Rifai: My plea is very simple. Do not wait for the knock on the door to learn the rules. Learn the rules about your Fifth Amendment rights and about your Sixth Amendment rights. Learn your right to remain silent, your right to have an attorney present, and your right basically to protect your life, to protect your liberty, to protect your license, to protect your family, and to protect your ability to practice and serve your patients.

Kevin Pho: Muhamad, thank you again for sharing your perspective and insight, and thanks again for coming back on the show.

Muhamad Aly Rifai: My pleasure. Thank you.