The U.S. Department of Justice (DOJ), Drug Enforcement Administration (DEA), Internal Revenue Service (IRS), Office of Inspector General (OIG), and other federal authorities are targeting Anaheim health care providers in fraud investigations. Providers targeted in these investigations need experienced legal representation in order to mitigate their risk of civil or criminal prosecution.
Federal health care fraud investigations can lead to civil monetary penalties, criminal fines, treble damages (three times the government’s actual losses), health care benefit program exclusion, and even federal imprisonment. In order to mitigate their risk of facing a judgment in civil or criminal court, health care providers that are under investigation must seek experienced legal representation, right away.
Oberheiden, P.C., is a federal health care fraud defense law firm that represents physicians, pharmacists, physician groups, durable medical equipment (DME) companies, laboratories, hospitals, clinics, hospices, company executives and billing administrators, and other clients in Medicare, Medicaid, Tricare, and Department of Labor (DOL) benefit fraud investigations. Our firm has a nationwide presence, and our attorneys are available to meet with new clients in Anaheim, CA. If your business or practice is being targeted by the U.S. Department of Justice (DOJ), Drug Enforcement Administration (DEA), Internal Revenue Service (IRS), Office of Inspector General (OIG) – or any other federal agency for alleged billing violations, illegal kickbacks, prescription drug diversion, or any other form of federal health care fraud – you need legal representation. Our health care fraud defense lawyers are available to take action in your case immediately.
Examples of our experience include:
- Representation of a health care provider and its principals in a federal fraud investigation involving the DOJ and FBI. Outcome: No civil or criminal liability.
- Representation of a health care provider and its principals in a federal fraud investigation involving the DOJ and OIG. Outcome: No civil or criminal liability.
- Representation of a health care provider and its principals in a federal fraud investigation involving the FBI and OIG. Outcome: No civil or criminal liability.
- Representation of a health care provider and its principals in a DOJ investigation following the issuance of a Medicare fraud subpoena by the OIG. Outcome: No civil or criminal liability.
- Representation of a health care provider and its principals in a large-scale criminal investigation involving numerous federal law enforcement agencies. Outcome: No civil or criminal liability.
What Is Health Care Fraud?
If all you know is that you are under investigation for health care fraud, this means that you only know part of the story. If your practice or business has garnered the federal government’s attention, this means that federal investigators and prosecutors are looking into certain very specific allegations against you. While each case is unique, typical allegations underlying Medicare, Medicaid, Tricare, and DOL fraud investigations include:
- Billing for medically-unnecessary services, supplies, or equipment
- Billing for services or supplies not actually rendered to patients
- Controlled Substances Act and DEA registration violations (e.g., prescription drug fraud or opioid diversion)
- Falsifying patient records, prescriptions, physician certifications, or election statements
- Double-billing the government and/or a private insurance company
- Upcoding or unbundling services or supplies in order to secure a higher reimbursement rate
- Other billing or coding violations
- Anti-Kickback Statute violations (unlawful kickbacks or referral fees)
- Stark Law violations (physician “self-referrals”)
In order to determine the specific allegations against which you need to defend yourself, the first step is to intervene in the government’s investigation. When you engage Oberheiden, P.C., to represent you, our attorneys will promptly make contact with the federal authorities handling your investigation in order to uncover:
- Which federal agencies are involved in the investigation?
- What triggered the investigation (g., automated comparative analysis of billing data or a “whistleblower” complaint)?
- How long has the investigation been ongoing?
- What types of information are the investigating agencies seeking to collect?
- Is the investigation civil or criminal in nature?
- How close are federal prosecutors to filing civil charges or seeking an indictment?
The sooner we can gather this information, the sooner we can start protecting you and the greater chance we will have to resolve your case before charges get filed. To get started with a free and confidential case assessment, call 888-519-4897 or contact us about your Anaheim health care fraud investigation online now.
What Statutes Do Federal Authorities Use to Investigate and Prosecute Health Care Fraud?
1. The False Claims Act
Under the False Claims Act (FCA), health care providers can be prosecuted for both the intentional and unintentional submission of “false or fraudulent” claims for federal program reimbursement. While unintentional violations carry the potential for substantial monetary penalties and program exclusion, criminal violations carry fines and up to five years in prison for each individual offense. With financial penalties applying on a “per-claim” basis, and with providers being liable for treble damages, total liability in an FCA investigation can easily reach into the six or seven figures.
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) prohibits offering, paying, soliciting, or receiving referral fees or other forms of “remuneration” in connection with federal health care benefit program referrals. This includes referrals for beneficiaries of Medicare, Medicaid, Tricare, and the DOL health care benefit program. The Anti-Kickback Statute also includes provisions for both civil and criminal prosecution, and it carries penalties similar to those imposed under the False Claims Act.
3. The Stark Law
The Stark Law prohibits physicians who participate in Medicare and Medicaid from engaging in so-called “self-referrals.” A self-referral is a referral for program-reimbursed business provided to (or received from) a related entity in relation to any of the following “designated health services”:
- Clinical laboratory services
- Physical therapy services
- Occupational therapy services
- Outpatient speech-language pathology services
- Radiology and certain other imaging services
- Radiation therapy services and supplies
- Durable medical equipment and supplies
- Parenteral and enteral nutrients, equipment, and supplies
- Prosthetics, orthotics, and prosthetic devices and supplies
- Home health services
- Outpatient prescription drugs
- Inpatient and outpatient hospital services
The Stark Law is a civil statute. Potential penalties include recoupments, civil monetary penalties, treble damages, and permanent loss of Medicare or Medicaid eligibility.
4. The Controlled Substances Act
The Controlled Substances Act imposes criminal penalties for fraudulent prescription practices, drug diversion, improper filling of prescriptions, and other forms of pharmaceutical fraud. Providers who violate the Controlled Substances Act can have their DEA registrations revoked, and they can also face criminal prosecution in federal district court.
5. The Federal Health Care Fraud Statute
The health care fraud statute, 18 U.S.C. 1347, makes it a crime to “knowingly and willfully . . . (1) . . . defraud [or attempt to defraud] any health care benefit program; or (2) . . . obtain [or attempt 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 health care benefit program.” While this language echoes the prohibitions of the False Claims Act and the other statutes listed above, 18 U.S.C. 1347 imposes possible prison sentences of 10 years, 20 years, or life behind bars, depending upon the existence and extent of any harm to patients resulting from a provider’s violations.
6. Other Federal Criminal Statutes
In addition to these statutes, in criminal health care fraud cases, prosecutors with the U.S. Attorney’s Office will often file charges for a number of other statutory offenses as well. These include:
- 18 U.S.C. 371 (criminal conspiracy)
- 18 U.S.C. 1028A (identity theft)
- 18 U.S.C. 1341 (mail fraud)
- 18 U.S.C. 1343 (wire fraud)
- 18 U.S.C. 1344 (bank fraud)
- 18 U.S.C. 1357 (money laundering)
- 21 U.S.C. 841 (distribution of controlled substances)
- 26 U.S.C. 7206 (tax fraud)
Why Choose Oberheiden, P.C., for Your Federal Health Care Fraud Case in Anaheim, CA?
When the success or failure of their defense depends heavily on their choice of legal representation, why do health care providers in Anaheim, throughout California, and nationwide choose the federal health care fraud defense lawyers at Oberheiden, P.C.?
- Thousands of Investigations Handled – Collectively, our attorneys have represented clients in thousands of investigations and hundreds of trials. We know what has worked well in the past, and we use our experience to our clients’ advantage.
- Personal Representation by Senior Attorneys – All clients work directly with the senior attorneys on our federal health care fraud defense team. We do not employ paralegals or junior associates.
- 24/7 Accessibility – When your future is on the line, you do not have time to wait around. We make ourselves available to our clients 24/7.
- Focus on Pre-Charge Resolution – We focus on resolving our clients’ cases prior to charges being filed whenever possible. This keeps you in control and protects you against the inherent uncertainty of going to trial.
- Skilled and Aggressive Trial Representation – If you have no choice but to fight for your right to practice at trial, our attorneys will use their extensive trial backgrounds to present an exhaustive defense in court.
Contact Oberheiden, P.C.
If you would like to speak with a member of our federal health care fraud defense team about your investigation in Anaheim, please call 888-519-4897 or request a free initial case assessment online. We will arrange for you to discuss your case with an attorney, in confidence, as soon as possible.
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