Alexandria Healthcare Fraud

Proven Alexandria Healthcare Fraud Lawyers

DEA registrants and other healthcare providers that bill Medicare, Medicaid, and other government programs are facing intense scrutiny from federal authorities in Alexandria, VA. If your business or practice is being targeted in a federal investigation, you need experienced legal representation, you need our skilled Alexandria healthcare fraud lawyers.

Healthcare providers in Alexandria, VA, are subject to constant scrutiny from federal agencies such as the U.S. Department of Justice, the Drug Enforcement Administration (DEA), and the Office of Inspector General (OIG). On the leading edge of medical care and in close proximity to Washington D.C., physicians, pharmacists, and other practitioners in Alexandria are uniquely situated to fall squarely within these agencies’ law enforcement cross-hairs.

Currently, federal authorities are targeting healthcare providers in civil and criminal investigations targeting two top law enforcement priorities: (i) Medicare fraud and fraud targeting other government healthcare benefit programs, and (ii) the improper prescription and dispensing of opioid medications. Program fraud costs the federal government billions of dollars annually, and the DOJ has publicly stated its belief that healthcare providers are significant contributors to the nation’s opioid epidemic.

Alexandria Healthcare Fraud Defense Attorneys Serving VA

If your healthcare business or medical practice is under investigation by the DOJ, DEA, OIG, or any other federal agency (for example, the Federal Bureau of Investigation (FBI) and Internal Revenue Service (IRS) frequently get involved in healthcare fraud investigations as well), it is imperative that you seek experienced legal representation immediately. Civil prosecution could mean recoupment, fines, and loss of program eligibility, while a criminal healthcare fraud conviction could lead to years, if not decades, behind bars.

At Oberheiden, P.C., we focus our practice on representing healthcare providers in federal fraud investigations. Our clients include physician-owned practices, pharmacies, pain management clinics, drug testing facilities, hospices, home health agencies, durable medical equipment (DME) companies, and individual practitioners and executives who have been accused of a broad range of fraud-related offenses. Our Alexandria healthcare fraud lawyers have resolved the majority of our clients’ investigations without civil or criminal liability, and not a single client of ours has lost his or her license to practice as a result of an investigation in which our attorneys were involved.

Healthcare Fraud: Explained

What does it mean to be accused of “healthcare fraud” under federal law? In broad terms, most healthcare fraud allegations fall into three categories:

  • Improperly billing Medicare, Medicaid, Tricare, the Department of Labor (DOL), or a private insurance carrier
  • Billing for medically-unnecessary services, whether or not they were rendered to patients
  • Engaging in improper practices with regard to prescribing, dispensing, or compounding prescription medications.

The specific allegations that fall under each of these categories are innumerable, and many forms of alleged healthcare fraud will fall under multiple categories. For example, a physician could be prosecuted for “upcoding” medically-unnecessary services in order to receive an inflated reimbursement, or a pain clinic could come under investigation for over-administering opioid medications and billing Medicare or Medicaid for the full quantity or volume administered.

Despite the breadth of unlawful practices that can be prosecuted as healthcare fraud, most investigations targeting legitimate providers focus on a subset of the most common violations. As a result, we routinely represent healthcare providers accused of fraudulent practices such as:

  • Upcoding
  • Unbundling
  • Billing for services not provided
  • Billing for medically-unnecessary services
  • Offering or accepting kickbacks
  • Improperly prescribing or dispensing opioid medications
  • Falsifying medical and billing records

If you are being targeted in a healthcare fraud investigation, it will be important to determine exactly why you are being targeted as soon as possible. When you engage our firm to represent you, our Alexandria healthcare fraud lawyers will intervene in the government’s investigation promptly in order to determine the nature of the allegations and begin building a custom-tailored defense strategy to protect you.

Healthcare Fraud: Statutes, Regulations and Other Sources of Authority

1. The False Claims Act

The False Claims Act (FCA) prohibits the submission of any “false or fraudulent” claim for payment by a federal healthcare benefit program. This covers all forms of Medicare, Medicaid, and Tricare billing violations, including those listed above. Under the FCA, healthcare providers can face investigations that are civil or criminal in nature. A civil investigation can also become criminal if federal agents find evidence of intent to defraud a federal healthcare benefit program, and keeping allegations civil is often a key defense strategy in False Claims Act investigations.

2. The Anti-Kickback Statute

The Anti-Kickback Statute (AKS) prohibits the offer, payment, solicitation, and acceptance of a referral fee or any other form of “remuneration” in connection with a patient referral for program reimbursed medical services. Similar to the False Claims Act, the Anti-Kickback Statute includes criminal penalties for intentional violations, and it imposes civil penalties for providers who lack the requisite “criminal state of mind” to face federal incarceration. While the AKS is extremely broad in its scope, it includes “safe harbors” for a number of compensation-based relationships. Many healthcare providers will be able to avoid prosecution by demonstrating that a safe harbor applies.

3. The Stark Law

The Stark Law prohibits what are commonly known as “physician self-referrals.” Under the Stark Law, it is unlawful for physicians to refer patients to other practitioners or healthcare entities with which they have a financial relationship if the referral is for a “designated health service.” Designated health services under the Stark Law include:

  • Clinical laboratory services
  • DME and supplies
  • Home health services
  • Inpatient and outpatient hospital services
  • Occupational therapy services
  • Outpatient prescription drugs
  • Outpatient speech-language pathology services
  • Parenteral and enteral nutrients, equipment, and supplies
  • Physical therapy services
  • Prosthetics, orthotics, and prosthetic devices and supplies
  • Radiation therapy services and supplies
  • Radiology and certain other imaging services

Similar to the Anti-Kickback Statute, the prohibitions under the Stark Law are subject to a number of exceptions. However, unlike the AKS, the Stark Law is exclusively a civil statute.

4. The Controlled Substances Act

The Controlled Substances Act outlaws all forms of prescription drug fraud. This includes providing medically-unnecessary prescription drugs to drug-dependent patients, selling medications, and all other forms of prescription drug diversion. Physicians, pharmacists, clinic operators, caregivers, and other healthcare providers can all potentially be charged with prescription-related offenses under the Controlled Substances Act, and compounding pharmacies are facing increased scrutiny from the DEA and other federal authorities as well.

5. The Federal Healthcare Fraud Statute

The healthcare fraud statute, 18 U.S.C. 1347, makes it unlawful for healthcare providers to “knowingly and willfully execute[], or attempt[] to execute, a scheme or artifice—(1) to defraud any healthcare benefit program; or (2) to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any healthcare benefit program.” 18 U.S.C. 1347 is a criminal statute with penalties including fines and up to 20 years behind bars.

6. Program Billing Regulations

Medicare, Medicaid, Tricare, and the various other federal benefit programs are each subject to a bevy of program-specific regulations. Violating these regulations can lead to investigation and prosecution for healthcare providers, most commonly under the False Claims Act. This is true for both intentional and unintentional billing mistakes, and the risk of prosecution makes it essential for program participants to maintain comprehensive compliance programs at all times.

7. DOJ Mandates

The Department of Justice, led by the Attorney General who reports directly to the President, sets policy regarding the federal government’s law enforcement priorities. The DOJ routinely issues mandates specifying not only priority areas for law enforcement, but also specific sets of individuals and entities to be targeted. For example, the DOJ has recently launched a number of multi-agency initiatives focused on combating opioid drug diversion by healthcare providers. The pilot program for its Opioid Fraud and Detection Unit is currently targeting providers in twelve “hot spots” around the country.

5 Reasons to Choose Oberheiden, P.C.’s Alexandria Healthcare Fraud Lawyers in VA

So, you have been contacted by federal agents. What now? You need to defend yourself in order to avoid prosecution, and this starts with hiring experienced legal representation. Here are five reasons why healthcare providers choose Oberheiden, P.C.:

  • Our Experience – Our Alexandria healthcare fraud attorneys have centuries of combined experience on both sides of federal healthcare fraud investigations.
  • Our Team Approach – Our defense attorneys and former federal prosecutors work as a team to pursue favorable outcomes for our clients.
  • Our Track Record – We have amassed a substantial track record defending our clients in federal healthcare fraud investigations.
  • Our Healthcare Focus – While we handle a broad range of federal matters, our focus is on healthcare fraud defense.
  • Our Commitment to Our Clients – Our clients come first in everything we do, and we are committed to protecting our clients from unwarranted consequences.

Schedule a Free and Confidential Case Assessment

If your healthcare business or practice is under investigation in Alexandria, contact our now to schedule a free and confidential case assessment with our highly-experienced Alexandria healthcare fraud attorneys. Call us 24/7 at 888-680-1745, or send us your contact information and we will be in touch shortly.

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