Orange County Healthcare Fraud Defense Lawyers
Seasoned Orange County Healthcare Fraud Defense Attorneys
If you’re a healthcare provider in Orange County, chances are high that you are (or may soon be) the target of a federal investigation. High-stakes fraud investigations are being conducted by the Drug Enforcement Administration (DEA) and the Department of Health and Human Services (DHHS) with increasing frequency into matters ranging from opioid diversion to payment of unlawful kickbacks and any number of alleged federal violations in between. If your business or practice is currently under such an investigation, you need the help of the experienced Orange County healthcare fraud defense lawyers at Oberheiden, P.C.
Oberheiden, P.C., is a federal healthcare fraud defense law firm that represents healthcare providers and other industry entities in both civil and criminal matters in California. Together, our proven Orange County healthcare fraud defense attorneys have well over a century of combined legal experience – including decades of experience as senior federal prosecutors – to contribute to the most effective defense of your case. The knowledge and skill offered by Oberheiden, P.C., is unparalleled, and our passion is helping clients to make smart decisions in order to avoid the unnecessary consequences of federal healthcare fraud investigations.
As you read this, you may be the subject of investigation for allegedly submitting “false” or “fraudulent” claims to Medicare, Medicaid, or TriCare. You may have been told that you’re contributing to the nation’s opioid epidemic. You may be the target of an investigation, the reasons for which you don’t even fully understand. If you’re facing these difficulties, we’d like to help. It’s our goal to clear your name so that you can get back to the business you know best.
What Is Healthcare Fraud?
To respond appropriately to an inquiry from the DEA, the DHHS Office of the Inspector General, or the Department of Justice (DOJ), the first step is understanding the basis for that inquiry. A number of agencies investigate alleged healthcare fraud, and the term can include any number of potential violations – both civil and criminal in nature.
To formulate the most effective defense possible, it’s important to answer two initial questions:
- Is this case civil or criminal; and
- What special task forces or agencies are involved in the investigation?
To answer those questions, a basic understanding of the different sources of authority involved in healthcare fraud investigations is helpful. Briefly, the laws pertinent to most healthcare fraud allegations are as follows:
1. The False Claims Act
Submitting false claims willingly to federal government programs like Medicare, Medicaid, and Tricare constitutes a violation of the False Claims Act (FCA). Under this law, you cannot submit any false claim (e.g., services not rendered, services unnecessary, and billing for more expensive services) for reimbursement. The law gives prosecutors the power to seek charges on a “per claim” basis, which could result in extravagant fines and both civil and criminal penalties.
2. The Anti-Kickback Statute
Healthcare professionals working with patients on Medicare, Medicaid, Tricare, and DOL programs cannot refer patients to services where they receive a referral fee (kickback) in return. Doing so is a direct violation of the Anti-Kickback Statute (AKS). Under the AKS, you could face criminal and civil penalties, including jail time and the loss of your practice.
3. The Stark Law
While the Stark Law‘s scope is limited in comparison to other federal statutes, it is not one to ignore and can result in sizeable civil penalties. Knowingly referring a patient to another service, office, or program, from which you stand to gain financially, is a violation of Stark Law. One example would be a physician that partially owns a laboratory and refers patients to that laboratory for all diagnostic testing simply for financial gain, even if there is not a medically sound reason for doing so.
4. The Controlled Substances Act
The CSA was created to control and regulate dangerous substances, and it’s one of the primary federal statutes utilized to prosecute providers suspected of engaging in pharmaceutical fraud. Pharmaceutical fraud can include knowingly selling prescription drugs, reselling prescription medications, trading counterfeit drugs, receiving kickbacks from manufacturers to prescribe one medication over another, and any number of other unlawful practices. Depending on its severity, a violation of the CSA can result not only in the loss of your practice, but in substantial civil and/or criminal penalties as well.
5. The Federal Healthcare Fraud Statute
The federal healthcare fraud statute, 18 U.S.C. 1347, makes it a federal crime to knowingly and intentionally defraud any healthcare benefit program, or to obtain, through false statements or promises, any of the money or property under the control of any healthcare benefit program. Like the False Claims Act, this statute is very broad and provides federal prosecutors with a wide range of opportunities to target healthcare providers.
6. Program Billing Regulations
In addition to being subject to the aforementioned federal statutes, healthcare providers who participate in Medicare, Medicaid, Tricare, DOL, or other similar health benefit programs are also subject to the strict billing regulations of those companies. Willfully or unknowingly violating those regulations could result in losing your ability to work with those programs as well as a variety of other penalties that may stem from an audit and investigation. Maintaining a continually updated in-house compliance program to keep abreast of the constantly changing rules for these programs is a wise decision to help mitigate your risk of prosecution.
All medical professionals should also monitor the Department of Justice news releases that are routinely issued on their website. Doing so will help you to identify potential risks to your practice and to track what priorities the DOJ has for the healthcare industry. Currently, the DOJ is focusing efforts on their Opioid Fraud and Abuse Detection Unit and the Prescription Interdiction & Litigation (PIL) Task Force and is seeking out physicians who have violated these laws.
In addition to the foregoing statutes, healthcare providers and related entities also need to be aware that DOJ prosecutors can also choose to seek evidence necessary to charge providers and company executives with crimes like mail fraud, wire fraud, tax fraud, money laundering, and a variety of other federal offenses as well. Being informed is the first step to being prepared. Once you are informed, you can turn to counsel to help you structure a defense uniquely customized to your particular circumstances. The highly experienced Orange County healthcare fraud defense lawyer at Oberheiden, P.C., should be that choice.
Five Reasons to Choose Our Orange County Healthcare Fraud Defense Attorneys at Oberheiden, P.C.
Once you are the subject of a federal investigation, you may find yourself overwhelmed. Providers facing these sorts of investigations can turn to Oberheiden, P.C., knowing that when they do, they’re relying on a firm with experience and knowledge of the various types of allegations that they may be facing. Our highly skilled Orange County healthcare fraud defense lawyers have defended clients throughout the healthcare industry accused under all of the statutes and provisions mentioned above.
As a medical provider, you have too much at stake to avoid hiring a firm with experience in these matters. Here are five reasons medical providers choose Oberheiden P.C.:
- Our Team Includes Former Federal Prosecutors – We have a team of seasoned litigators, and many of our defense attorneys include former federal prosecutors who have devoted their careers to healthcare fraud cases.
- Our Extensive Knowledge of the Federal Healthcare Fraud System – Our highly skilled Orange County healthcare fraud defense legal team understands these investigations, and we can help you to identify what triggered an investigation in the first place. Our healthcare fraud attorneys have handled thousands of healthcare fraud audits, investigations, and prosecutions, including numerous cases in Orange County. We can put that knowledge and experience to work for you.
- Our Robust Track Record – We get involved in the case as early as possible, and we have a track record of stopping investigations before they reach federal indictment.
- Our Focus on Federal Healthcare Defense – Our firm focuses exclusively on federal law cases, and our established Orange County healthcare fraud defense lawyers have the experience required to defend clients representing all sectors of healthcare, including hospice care, physicians, pharmacies, hospitals, home care services, emergency clinics, and more.
- Our Customized Defense Strategies that Work – We have proven defense strategies and years of experience implementing them. Our Orange County healthcare fraud defense attorney tailors our approach to the unique aspects of our clients’ cases so that they receive the aggressive, effective defense they need.
Frequently Asked Questions
Q: Is healthcare fraud a crime?
Under the False Claims Act, Anti-Kickback Statute, and various other federal laws, healthcare fraud can be charged as either a civil or criminal offense. Healthcare fraud investigations will often lead to charges for conspiracy, money laundering, mail fraud, wire fraud, and other federal crimes as well. In criminal healthcare fraud cases, providers and their personnel can face penalties including (but not limited to) enormous fines, long-term imprisonment, and loss of federal healthcare benefit program (i.e. Medicare, Medicaid, and Tricare) eligibility.
Q: Do I need to worry about a whistleblower who came forward with allegations of healthcare fraud?
Since whistleblowers stand to receive a portion of any amount recovered through a healthcare fraud action, it is easy to write off a whistleblower’s allegations as self-serving. However, it is important for practitioners and management teams to take these allegations seriously, as they can—and frequently do—result in significant liability. Furthermore, if the whistleblower presents enough evidence to the federal government, it may intervene in the lawsuit, meaning federal investigators and prosecutors take over the case. Even if the government does not intervene, however, the whistleblower may decide to proceed with the case on their own. Thus, it is critical that any healthcare provider contact an experienced California federal healthcare fraud defense attorney once they learn about a whistleblower’s allegations.
Q: When should I contact an Orange County, California federal healthcare fraud defense attorney?
The best time to reach out to a California federal healthcare fraud defense attorney is before the need for one arises. Orange County federal healthcare fraud defense attorneys can be instrumental in developing iron-clad compliance programs that will protect you and your organization in the event of an isolated incident of non-compliance. It is never too late to create a compliance program, as federal prosecutors base their decision on whether to pursue certain charges in part on whether an organization made any remedial efforts. However, an Orange County, CA federal healthcare fraud defense attorney can also come in you or your organization has been targeted to help develop a compelling defense to the charges.
Discuss Your Healthcare Fraud Defense Today in Confidence
As a medical professional working in Orange County, you know the damage that can be done by allegations of healthcare fraud, even if you are innocent. That is why our team suggests you speak with an attorney as quickly as possible after these allegations arise. Contact one of our healthcare fraud defense attorneys for a risk-free, confidential consultation at 888-680-1745 or inquire online now. Our dedicated Orange County healthcare fraud defense attorneys are available 24 hours a day, 7 days a week, to discuss your concerns.
Additional Pages for Orange County, California
- Orange County False Claims Act & Qui Tam defense
- Orange County federal criminal defense
- Orange County healthcare compliance
- Orange County hospice & home health fraud defense
- Orange County Medicare fraud defense