California Healthcare Fraud Defense Attorney
Proven California Healthcare Fraud Defense Lawyers
California is a key battleground in the federal government’s fight against healthcare fraud. Healthcare providers from San Diego to San Francisco are currently at high risk for being targeted in civil and criminal fraud investigations. If you have been contacted by federal authorities, our California healthcare fraud defense lawyers can help. Call 888-680-1745 now.
As a healthcare provider, one of the greatest threats to your practice is the risk of being targeted in a federal healthcare fraud investigation. Due to the prevalence of billing fraud and other schemes targeting federal benefit programs in recent years, federal authorities are aggressively targeting all entities that bill Medicare, Medicaid, and Tricare, and legitimate healthcare providers are increasingly getting caught up in high-stakes federal cases. This is particularly true in states such as California, where large numbers of patients and providers mean a high perceived risk for fraudulent billings.
At Oberheiden, P.C., our California healthcare fraud defense lawyers can help protect healthcare providers against unwarranted consequences due to aggressive fraud enforcement tactics and investigations. With a nationwide presence, we have seen the scope of the federal government’s efforts to combat program fraud in California and across the country. We know that California providers are particularly at risk for falling within the government’s crosshairs. But, we also know that fraud allegations can easily be misguided. In recent years, our proven California healthcare fraud defense attorneys have helped numerous clients avoid prosecution following investigations involving the Department of Justice (DOJ), Drug Enforcement Administration (DEA), Office of Inspector General (OIG), and other agencies.
If you have been contacted by federal agents, it is critical that you engage legal counsel immediately. Federal healthcare fraud investigations can escalate quickly, and you need to be able to effectively intervene in the investigation in order to mitigate the risk of significant consequences. While a federal healthcare fraud investigation can lead to criminal charges under laws such as the False Claims Act and Anti-Kickback Statute, in many cases, it is also possible to avoid charges entirely. At Oberheiden, P.C., we focus on keeping our clients’ investigations civil in nature, and our skilled California healthcare fraud defense lawyers aim to resolve our clients’ cases without charges being filed, whenever possible.
What Is Healthcare Fraud?
As a healthcare provider in California, if you are under investigation by the DOJ, DEA, or OIG, this typically means that you are at risk for being charged with federal healthcare fraud. So, what is “healthcare fraud”?
Most legitimate healthcare providers are surprised to learn that they are being investigated by the federal government, and many are equally surprised to learn just how broad the definition of “healthcare fraud” truly is. The term “healthcare fraud” does not refer to any specific type of unlawful conduct. Instead, it refers to a broad range of offenses defined under a variety of statutes that all generally involve obtaining funds from Medicare, Medicaid, Tricare, and other federal healthcare benefit programs through improper means. As a result, while facing a healthcare fraud investigation could mean that your Medicare billings reflect certain markers for fraud, it could also mean that the DOJ or OIG is looking into your relationship with a vendor or colleague for possible unlawful “kickbacks” or referral fees.
Another aspect of the definition of “healthcare fraud” that many providers find surprising is that “fraud” does not necessarily imply “intent.” While evidence of intent is generally required for a successful criminal healthcare fraud prosecution, civil investigations can lead to fines, program exclusion, and other penalties – even for unintentional violations. As a result, even if you have done your best to comply with the Medicare, Medicaid, and Tricare billing guidelines, this does not necessarily mean that you are immune from prosecution. If you have improperly billed the federal government, you could be charged civilly, and your civil case could have devastating consequences for your business or practice.
At Oberheiden, P.C., our California healthcare fraud defense attorneys represent physicians, pharmacists, practice owners, and other healthcare providers in civil and criminal healthcare fraud investigations involving allegations of:
- Anti-Kickback Statute violations
- Controlled Substances Act violations (including prescription drug fraud)
- False Claims Act violations
- Stark Law violations
- Medicare, Medicaid, and Tricare fraud
- Department of Labor (DOL) fraud
- Providing and billing for medically-unnecessary services
- Billing for services not actually rendered to patients
- Falsifying patient records, prescriptions, physician certifications, and election statements
- All other forms of “healthcare fraud”
Sources of Authority in Federal Healthcare Fraud Investigations
1. False Claims Act (FCA)
The False Claims Act (FCA) prohibits the submission of any “false or fraudulent” claim for payment by a federal government healthcare benefit program. This includes both intentional and unintentional billing errors, and it applies to all providers who participate in Medicare, Medicaid, Tricare, and/or any other benefit program(s). Civil penalties for unintentional violations of the FCA include fines, recoupments, treble damages, and program exclusion, while providers charged criminally under the FCA can face federal incarceration.
2. Anti-Kickback Statute (AKS)
The Anti-Kickback Statute (AKS) prohibits the offer, payment, solicitation, or receipt a referral fee or any other form of “remuneration” in connection with a referral for a Medicare, Medicaid, Tricare, or DOL beneficiary. Similar to the False Claims Act, the AKS includes both civil and criminal enforcement provisions. While the AKS’s prohibitions are extremely broad, the law also includes several “safe harbors.” And demonstrating safe harbor compliance is a key defense strategy for many providers.
3. Stark Law
The Stark Law prohibits so-called “physician self-referrals.” The Stark Law is exclusively a civil statute, and its scope is limited to physicians, their family members, and their related entities. Similar to the Anti-Kickback Statute, the Stark Law contains broad prohibitions that are tempered by safe harbors and exclusions.
4. Controlled Substances Act (CSA)
The Controlled Substances Act (CSA) is one of the primary federal statutes used to prosecute healthcare providers who prescribe, administer, and dispense prescription medications. In addition to DEA registration violations, other common allegations under the CSA include prescribing medically-unnecessary medications, diverting prescription drugs, and other forms of prescription drug fraud.
5. Federal Healthcare Fraud Statute
The healthcare fraud statute, 18 U.S.C. 1347, makes it a federal offense 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.” The definitions of “knowingly” and “willfully” are much broader than most people would expect. And as a result, many providers will be at risk for criminal prosecution under 18 U.S.C. 1347 in federal healthcare fraud investigations.
6. Program Billing Regulations
Medicare, Medicaid, Tricare and the DOL healthcare benefit program are each subject to their own unique and highly complex set of billing rules and regulations. Violations of these rules and regulations can be prosecuted as violations of the False Claims Act and 18 U.S.C. 1347. Providers who have failed to implement comprehensive compliance programs can be at severe risk for substantial penalties.
7. DOJ Mandates
The Department of Justice is the nation’s chief law enforcement agency, and part of its role to is to set policy with regard to top law enforcement initiatives and priorities. The DOJ is increasingly devoting its resources (and asking other agencies to devote their resources) to combating healthcare fraud, with particular emphasis on Medicare fraud and opioid prescription-related offenses. The DOJ also determines which states deserve the most attention, and California is currently among the states facing the heaviest amount of scrutiny.
5 Reasons to Choose Oberheiden, P.C., for Your Federal Healthcare Fraud Case in California
When facing a federal healthcare fraud investigation, your choice of legal representation can dramatically impact the outcome of your case. Here are five reasons why healthcare providers in California and nationwide trust the defense team at Oberheiden, P.C.:
- Experience on Both Sides of Healthcare Fraud Investigations – Many of our federal defense attorneys are former prosecutors with decades of experience inside of the DOJ.
- Favorable Results Prior to Charges Being Filed – Our California healthcare fraud defense attorneys have resolved the majority of our clients’ investigations without civil or criminal charges.
- Exclusive Focus on Federal Healthcare Fraud Defense – Our practice focuses exclusively on federal healthcare fraud defense. We are known for our experience in complex federal investigations throughout California and nationwide.
- Aggressive Intervention and Personalized Representation – We take an aggressive approach that starts with intervening in the government’s investigation right away, and we custom tailor our representation to the unique facts of each individual client’s case.
- Trial-Ready Defense Strategies – While we seek to resolve all cases as quickly as possible, we are fully prepared when it is in a client’s best interests to fight for justice at trial.
Frequently Asked Questions
Q: Why am I being accused of ‘healthcare fraud’?
Federal agencies, including the OIG and DEA, are targeting physicians, pharmacists, and other providers for healthcare fraud in California – and they are doing so aggressively. “Healthcare fraud” is a blanket term that covers various types of civil and criminal offenses, including violations of the False Claims Act, the Anti-Kickback Statute, and the Stark Law. Billing and coding violations are common triggers for federal healthcare fraud investigations, although numerous other alleged forms of impropriety can lead to federal action as well.
Q: What can I do to avoid healthcare fraud charges?
The best way to avoid healthcare fraud charges is to take a proactive approach to compliance. This means developing a robust compliance strategy that not only provides employees with the necessary guidance to ensure their actions comply with applicable laws and regulations but also conveys management’s commitment to compliance. When the federal government identifies a potential violation, one of the factors it considers when determining how to proceed is the existence of an effective compliance program and whether the practice follows the spirit of the program. A California federal healthcare fraud defense attorney can identify potential areas of non-compliance and work with your organization to address any deficiencies. However, if healthcare fraud investigators have already initiated an investigation, it is essential to meet with a California federal healthcare fraud defense attorney to discuss developing a defense strategy.
Q: What is the Stark Law?
The Stark Law is a federal statute that limits the situations in which a physician can make a referral for certain services that are reimbursable by Medicare. Specifically, the law prohibits a healthcare provider from referring patients to another provider with whom the referring physician has a “financial relationship.” For example, a doctor who is a co-owner of a lab needs to be careful when referring patients to the lab. Notably, not all of these referrals are prohibited under the Stark Law, as important exceptions apply. To learn more about creating a legitimate referral program, contact a California federal healthcare fraud defense attorney today.
Schedule a Free Initial Consultation with Our California Healthcare Fraud Defense Attorney
If you would like to speak with our federal healthcare fraud defense team about your investigation in California, we encourage you to contact us 24/7. You can call our California healthcare fraud defense lawyers at 888-680-1745 or contact us online. If a member of our team is not available immediately, we will respond to your inquiry as soon as possible.
Additional Pages for California
- California federal criminal defense
- California False Claims Act & Qui Tam defense
- California federal grand jury subpoena defense
- California hospice & home health fraud defense
- California medical license defense
- California Medicare fraud defense
- California Medicare penalties
- California Workers Compensation Fraud Defense