California Workers’ Compensation Fraud Defense Lawyers

Federal Defense Lawyers for California Workers’ Compensation Clinics and Health Care Providers Targeted in U.S. Department of Labor Office of Inspector General (OIG) Investigations

For workers’ compensation clinics and other health care providers in California that bill the U.S. Department of Labor (DOL) for services provided to federal workers and other program beneficiaries, compliance presents a significant burden. Not only are the regulations that govern DOL billing inordinately complex, but they are also difficult to understand and interpret, and this makes them nearly impossible to follow. Yet, the DOL’s Office of Inspector General (OIG) vigorously enforces clinics’ and other providers’ compliance obligations, and even unintentional violations can lead to recoupments, fines, and other substantial penalties.

If your business or practice is under investigation by the OIG for workers’ compensation fraud in California, it is important that you promptly engage experienced defense counsel. Under the Federal Employees’ Compensation Act and other statutes, federal employees and other program beneficiaries are entitled to a certain standard of care, and clinics and providers must consistently meet this standard while maintaining strict compliance with the rules and restrictions on DOL billing. Any failures have the potential to trigger an OIG investigation, and an OIG investigation can potentially lead to civil, or even criminal, fraud charges.

Our Attorneys Defend Workers’ Compensation Clinics and DOL Providers in California and Nationwide

At Oberheiden, P.C., our federal defense lawyers bring centuries of combined experience to representing workers’ compensation clinics and other DOL health care providers in OIG investigations and trials. With a team that includes several former federal health care fraud prosecutors, we are able to quickly intervene in our clients’ cases and execute custom-tailored defense strategies that are designed to protect our clients against federal charges. If you have been contacted by the OIG – or by agents from any other federal law enforcement agency (such as the DOJ, DEA, FBI, HHS, IRS, or USPIS) – you need to speak with a lawyer before you answer any questions or provide any information to the federal government. Our attorneys are available 24/7, and we can begin working on your case in California immediately if necessary.

Office of Workers’ Compensation Programs (OWCP) Investigations

The U.S. Department of Labor’s OIG focuses much of its effort on targeting clinics and other health care providers in cases involving programs managed by the Office of Workers’ Compensation Programs (OWCP). These cases can involve a broad range of allegations, from unintentional billing errors to offering patients illegal “incentives” to enter into rehab programs. Programs managed by the OWCP include:

Federal Employees’ Compensation Program (Division of Federal Employees’ Compensation)

The Federal Employees’ Compensation Program is the primary workers’ compensation program for federal employees. It provides coverage for all types of work-related injuries and illnesses, and the Division of Federal Employees’ Compensation is currently focusing heavily on combatting opioid abuse among federal workers. 

Energy Employees Occupational Illness Compensation Program

The Energy Employees Occupational Illness Compensation Program (EEOICP) provides compensation to federal workers, contractors, and their families in cases involving radiogenic cancer, chronic beryllium disease, beryllium sensitivity, and chronic silicosis resulting from exposure to radiation, beryllium, or silica at covered federal facilities.

Longshore and Harbor Workers’ Compensation Program

The Longshore and Harbor Workers’ Compensation Program (LHWCP) exists to, “minimize the impact of land based, maritime employment injuries and deaths on the injured employees and their families by ensuring that workers’ compensation benefits are provided promptly and properly.” The LHWCP pays out more than $1 billion for the benefit of injured workers and their families each year.

Common Allegations in Federal Workers’ Comp Fraud Investigations in California

Similar to other types of health care fraud investigations, federal workers’ compensation fraud investigations most-commonly involve allegations of billing violations. However, other allegations are common as well; and, when your business or practice is being targeted by the DOL’s OIG, you must be careful to ensure that you have a clear picture of all of the allegations against you. Failure to successfully defend against even a single allegation can leave you vulnerable, and the consequences of this vulnerability can be severe. 

Common allegations against federal workers’ compensation clinics and other DOL-participating health care providers in California include:

  • Upcoding through the use of improper modifiers
  • Upcoding through specification of an inappropriate level of care
  • Routine high-level billing (e.g., for “Supplies 99070”)
  • Billing for two mutually-exclusive codes
  • Delayed discharge of DOL beneficiary patients
  • Low or inconsistent return-to-work rate
  • Inadequate supervision of care providers (including medical doctors, physical therapists, chiropractors, and massage therapists)
  • Failure to maintain adequate documentation to support DOL reimbursement
  • Excessive or unnecessary prescription of opioid medications and other prescription drugs
  • Improper integration of licensed professional counselors (LPCs) and psychologists
  • Billing for services that are not medically-necessary
  • Billing for services not actually rendered to DOL beneficiary patients
  • Unlawful referral agreements and marketing contracts with agencies, unions, and other health care providers
  • Illegal medical directorship arrangements
  • Failure to implement an adequate OWCP compliance program

While this list is long, it is not exclusive. As a DOL-participating health care provider, all aspects of your practice are subject to constant scrutiny. Whether due to “anomalous” billing data, a patient complaint, or an employee whistleblower claim, regardless of why your practice is being targeted, what you need to do is to speak with an attorney as soon as possible.

Why Do California Workers’ Compensation Clinics and DOL Health Care Providers Choose Oberheiden, P.C.?

While our firm represents clients in more than 45 states nationwide, a significant portion of our practice involves representing health care providers in California. So, why do so many California health care providers who treat injured federal workers and other program beneficiaries choose Oberheiden, P.C.?

1.  Our Focus on Federal Health Care Fraud Defense

We are committed to fighting for workers’ compensation clinics, DOL health care providers, and other licensed professionals and medical businesses that are being targeted in federal fraud investigations and prosecutions. We know the professional devastation that can result from being targeted, and we also know that allegations of federal program fraud are very often misguided. Our attorneys can help you demonstrate your compliance without giving information to the government unnecessarily; and, if necessary, we will fight vigorously to protect you against a criminal conviction in federal district court.

2. Our In-Depth Knowledge of Federal Workers’ Compensation and DOL Billing Practice

Even within the context of federal health care fraud, there are a number of issues that are unique to federal workers’ compensation and DOL billing practice. Our attorneys understand these issues, and we know how to deal with them during federal investigations. Have you unlawfully marketed your services to DOL patients? Did you fail to maintain the requisite supervision for DOL reimbursement eligibility? Even if the OIG says yes, we may be able to successfully argue that you do not deserve to face federal prosecution.

3. Our In-Depth Knowledge of the Pertinent Medical Issues

Another common issue in DOL fraud cases is alleged lack of medical necessity. If a particular service is not “medically necessary” (as determined by the federal workers’ compensation billing guidelines), then it is not eligible for reimbursement by the DOL. As a result of our extensive experience in federal health care cases, not only are we intimately knowledgeable about the legal issues involved in our clients’ cases, but we have a sound understanding of the relevant medical principles as well.

4. Our Focus on Pre-Charge Resolution

While being targeted in an OIG investigation can be damaging for your practice, being convicted on federal charges can be devastating. We understand the ramifications of being accused of federal workers’ compensation fraud, and we will do everything in our power to resolve your case as quickly and favorably as possible.

5. Our Accessibility and Client-First Approach to Legal Representation

As our client, we expect you to contact us whenever you have a question or information to share about your federal workers’ compensation fraud case. Our attorneys will be available to you 24/7, and we can take your case on an emergency basis if necessary. If you are being targeted by the DOL’s OIG, the most important thing you can do is to speak with an attorney immediately. We are ready to help, and we are prepared to do whatever it takes to protect your privilege to practice in California.

Facing allegations of federal workers’ compensation fraud is a serious matter. Regardless of the circumstances involved, you cannot afford to take your situation lightly. You must assume that the OIG will keep investigating until it has the evidence it needs to press charges, and you must devote your time and attention to protecting yourself against unnecessary consequences. 

Call Oberheiden, P.C. Now for a Free and Confidential Case Assessment 

How can we help you? If you have been contacted by the DOL’s OIG, if federal agents have shown up at your door, or if you have received a subpoena or target letter in California, we encourage you to contact us right away. To speak with a member of our federal health care fraud defense team in confidence, call (214) 692-2171 or inquire online now. 

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