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DOL Fraud Explained by Federal Defense Attorneys

Just like Medicare Fraud, DOL Fraud assumes that a health care provider attempted to, or did in fact, defraud the federal government, or that he or she assisted others in defrauding the federal government, with an underlying illegal motivation.


Services Not Rendered

One of the most common and notorious accusations by agents investigating DOL fraud are that a particular service that the government was billed for or a particular device or pharmaceutical product were in fact never rendered to the patient. In more extreme scenarios, this could also include the submission for claims of patients that never existed, such as so-called ghost patients.

Up-Coding and Bundling

A large portion of government investigations in the area of DOL fraud involves upcoding and bundling of health care services. Upcoding occurs when a health care provider submits a claim for a procedure that is more serious and therefore more expensive than the actual diagnosis. Bundling and unbundling of services occurs when services with group rates are lumped together to request the group reimbursement rate or when one service is split into multiple services to receive a higher rate by billing for each separately.

Kickbacks

Under federal law, any remuneration, any offer, any payment, any solicitation, or any receipt of remuneration to entice or compensate or reward a patient referral payable by a government health care program, such as DOL, is illegal. Courts consider even the smallest attempt of bribing referrals a violation of the federal Anti-Kickback Statute, 42 U.S.C. § 1328-7b(b) and the Federal False Claims Act.

Who Are Targets?

The reasons a DOL provider may become a target of an investigation vary from case to case. Generally speaking, most audits by the Department of Labor are initiated due to one of the following events:

  • Complaint by Former Employee
  • Complaint by Former Patient
  • Excessive or Suspicious Billing Practice
  • Connection to Another DOL Investigation

What Are the Penalties?

DOL program fraud and general health care fraud constitute serious federal felonies that can be charged in one of two ways.


Civil Penalties

The government can request recoupment, often under the provisions of the False Claims Act. In this case, the government will ask for the difference between what was charged and paid to the provider and what should have been charged and paid. In addition to repaying the difference, the government typically imposes a civil fine that will be a percentage of the total damage that was caused by the billing error.

Criminal Penalties

On the other hand, health care fraud and DOL program fraud can also be charged as criminal felonies. In such a case, federal prosecutors will typically attempt to indict the responsible owners and staff at the health care company with health care fraud under 18 U.S.C. § 1347. Each count under 18 U.S.C. § 1347 carries a maximum sentence of 10 years imprisonment.

Is My Case Civil or Criminal?

One of the most important questions in any DOL investigation is to find out whether the case is civil or criminal. DOL case investigations can go either direction and government lawyers are divided into civil and criminal prosecutors.

The best way to find out what exactly has prompted the government to audit you is to contact the agents and lawyers in charge and establish a dialogue. Trained and experienced defense lawyers will typically be able to extrapolate from this communication why and what for the government is interested in your practice. Understanding the context and the objectives of the investigation allow to elaborate the proper defense strategy.

Sometimes, the experienced DOL fraud defense attorneys of the Oberheiden Law Group, some of whom are former federal health care prosecutors themselves, will be able to find an answer to this critical question already by looking at the subpoena a client received or by the way agents contacted the health care provider.

Finding out whether the investigation civil or criminal is one of the top priorities when we launch our Emergency Defense Package in federal investigations.

What is the Emergency Defense Package?

Targets often learn about their alleged involvement in federal program fraud when federal agents show up at their door either to serve a subpoena or to inspect the premises with a search warrant. When that’s the case, time is of the essence.
Over the years, Dr. Nick Oberheiden and his team have developed certain protocols that allow immediate action-taking. Case after case, these protocols have proven to work because they allow the implications of important steps that can make a huge difference in outcome, or may even turn a case from possible criminal to civil.

The Emergency Defense Package contains:

  • General Protocols: What to Do
  • Instructions for Management: How to Deal with Agents
  • Instructions for Management: How to Deal with Employees
  • Instructions for Employees
  • Document Retention Forms
  • Compliance Examination Instructions
  • Important Contact Information

DOL Cases and Experience

The defense attorneys of the Oberheiden Law Group, PLLC know how to protect you, your livelihood, and your family. Health care fraud and DOL program fraud are serious accusations. You can expect a serious defense approach from us.

Our team of experienced fraud defense lawyers has been retained in a great variety of health care fraud cases in general and in DOL health care fraud cases in particular. In those cases, we were retained to defend physicians, health care business owners, and patients against health care fraud, bribery, and anti-kickback violations. We have concluded dozens of federal, civil, and criminal health care fraud investigations resulting in no civil and no criminal liability for our clients.

Defending You

The Oberheiden Law Group, PLLC has successfully appeared in some of the largest DOL investigations in the country. In many health care fraud cases, our attorneys were able to obtain no civil or criminal liability results for our clients and were able to dismiss the government’s case in its entirety. Contact us today to speak with an experienced attorney.

FAQs


Which agencies are involved in health care investigations?

Most DOL health care investigations are led by agents and special agents of the OIG and the U.S. Postal Service.

How long does it take to resolve the investigation?

The answer depends on the seriousness of the charges, whether the case is civil or criminal, and the role of the client in the case.

What experience do you have with DOL cases?

The Oberheiden Law Group has been involved in some of the largest and the most complex DOL investigations in the country.

Who will handle my case at the Oberheiden Law Group, PLLC?

We value personal attention and communication with our clients. All cases will be handled by senior attorneys.

Who will represent me?

We do not use paralegals or junior lawyers and all clients are represented by a team effort, led by former federal prosecutors and experienced health care attorneys.

What are the penalties for DOL Fraud in civil cases?

In civil DOL cases, the government can demand a repayment of overpayments plus damages and penalties. The amount of penalties, if applicable, may be reduced and negotiated by our experienced attorneys.

What are the penalties for DOL Fraud in criminal cases?

We do not use paralegals or junior lawyers and all clients are represented by a team effort, led by former federal prosecutors and experienced health care attorneys.

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