WSJ logo
Forbes logo
Fox News logo
Bloomberg logo
Los Angeles Times logo
Washington Post logo
CNN logo
Telemundo logo
New York Times
NY Post logo
NBC logo
Daily Beast logo
USA Today logo
Miami Herald logo
CNBC logo
Dallas News logo

San Francisco Healthcare Fraud Defense Attorneys

What do you need to know if your San Francisco healthcare practice or medical business is under investigation for fraud? Find out from the San Francisco federal healthcare fraud defense lawyers at Oberheiden, P.C. For a free and confidential case assessment, call 888-680-1745.

San Francisco Healthcare Fraud Defense Attorneys

For healthcare providers and other entities in the healthcare industry, federal fraud investigations can lead to devastating consequences. Laws such as the False Claims Act and Anti-Kickback Statute impose civil and criminal penalties for statutory violations. And physicians, pharmacists, company executives, and other individuals targeted in these investigations can face crippling financial penalties, loss of federal healthcare benefit program eligibility, and even federal imprisonment.

At Oberheiden, P.C., our federal team is committed to protecting healthcare clients in federal fraud investigations in San Francisco, California and nationwide. Our healthcare fraud defense attorneys represent clients at all stages of the process – from initial target letter or subpoena through trial and appeal, while constantly striving to achieve a favorable outcome as quickly and cost-effectively as possible. Comprised entirely of seasoned litigators (including several former federal healthcare fraud prosecutors), our team is capable of effectively representing clients under the most challenging of circumstances and when the most severe penalties possible are on the table.

So, your business or practice is under investigation for healthcare fraud. What now? Accepting that you are at risk for practice or business-threatening fines and program exclusion, and possibly even at risk for being sentenced to prison, your immediate first step needs to be to engage experienced legal representation. At Oberheiden, P.C., our San Francisco federal healthcare fraud defense attorneys are available 24/7, and we can arrange for you to meet with a member of our federal healthcare fraud defense team over the phone or in-person as soon as possible.

What Is Healthcare Fraud?

What comes to mind when you think about “healthcare fraud”? For most people, the term conjures up images of seedy practitioners and scam artists who devote more effort to gaming the system than they do to treating their patients. But, while this is undoubtedly one example, legitimate – and even prominent – healthcare providers can get caught up in federal healthcare fraud investigations as well. And with the federal government’s heavy reliance on the analysis of billing data and claims from whistleblowers, a provider’s reputation is virtually meaningless when it comes to the risk of being targeted in a federal investigation.

One of the most common misconceptions about healthcare fraud is that, in order to be liable, you need to have overbilled the government with intent. But, while intent is a factor in criminal prosecutions under the False Claims Act, Anti-Kickback Statute, and various other federal healthcare laws, evidence of intent is not necessary to establish liability for civil healthcare fraud. As a result, even providers who do their best to maintain effective billing compliance programs can face liability for “fraudulent” billing practices such as:

  • Improperly prescribing, administering, or dispensing prescription medications (such as prescription opioids), regardless of intent
  • Offering, paying, soliciting, or accepting an illegal “kickback” or referral fee, even without knowledge that the transaction was unlawful
  • Unintentionally overbilling Medicare, Medicaid, Tricare, or the Department of Labor (DOL) healthcare benefit program
  • Unintentionally billing Medicare, Medicaid, Tricare, or the DOL for medically-unnecessary services or supplies
  • Unintentionally billing Medicare, Medicaid, Tricare, or the DOL for services or supplies not actually rendered to patients
  • Violating the standards for maintenance of patient records and election statements or for issuing prescriptions or physician certifications

Do you know why your healthcare practice or business is under investigation? This is somewhat of a trick question. At this point, even if you think you may know why your practice or business is being targeted, the answer needs to be a resounding, “No.”

Until you intervene in the government’s investigation, the simple fact is that you don’t know why you are being targeted. To defend yourself, you need to know what the government knows (or thinks it knows), and you need to know it now. With our attorneys’ experience on both sides of thousands of federal investigations, we can take the steps necessary to promptly intervene in your investigation and determine the scope and nature (i.e., civil or criminal) of the charges against you.

Sources of Authority in Federal Healthcare Fraud Investigations

1. The False Claims Act

The False Claims Act (FCA) prohibits the submission of any “false or fraudulent” claim for payment by the federal government. This includes improper billings submitted to Medicare, Medicaid, Tricare, and the DOL. Civil penalties under the FCA include fines, recoupments, treble damages, and program exclusion; while providers, executives, board members, and other individuals, who are charged criminally, can face financial penalties and federal incarceration.

2. The Anti-Kickback Statute

The Anti-Kickback Statute (AKS) prohibits healthcare providers from offering, paying, soliciting, or receiving referral fees or other forms of “remuneration” in connection with Medicare, Medicaid, Tricare, and DOL beneficiary referrals. While Anti-Kickback Statute investigations often target providers and other entities that actively offer or solicit unlawful payments, simply accepting an improper payment – even without bad intent – is enough to trigger AKS liability.

3. The Stark Law

The Stark Law prohibits improper payments between physicians and their related entities – or so-called “physician self-referrals.” The Stark Law imposes civil penalties similar to the False Claims Act (unlike the FCA and the AKS, the Stark Law does not include provisions for criminal prosecution). However, physicians and executives who intentionally engage in improper referral transactions involving program-reimbursed funds can face charges under other statutes as well.

4. The Controlled Substances Act (CSA)

The Controlled Substances Act (CSA) is the primary statute that the DEA uses to investigate and prosecute healthcare providers for pharmaceutical fraud and other prescription drug-related offenses. The CSA also establishes the federal registration regime for providers who administer, prescribe, and dispense controlled-substance medications. In addition, providers whose practices involve prescription drugs can face both routine and non-routine investigations.

5. The Federal Healthcare Fraud Statute

The healthcare fraud statute, 18 U.S.C. 1347, makes it a federal offense to “knowingly and willfully . . . (1) . . . defraud [or attempt to defraud] any healthcare 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 healthcare benefit program.” Violations of 18 U.S.C. 1347 carry penalties that include fines and prison sentences ranging from 10 years to life behind bars.

6. Program Billing Regulations

The Medicare, Medicaid, Tricare, and DOL billing regulations are extraordinarily complex, and they are at the center of many federal healthcare fraud investigations. Program participants who violate the applicable regulations can face charges under the False Claims Act, 18 U.S.C. 1347, and other federal civil and criminal statutes.

7. Other Federal Criminal Statutes

In addition to the statutes discussed above, healthcare providers and other individuals and entities targeted in federal healthcare fraud investigations can face charges under a bevy of other criminal statutes as well. For example, bank fraud, mail fraud, wire fraud, money laundering, and conspiracy charges are all common in criminal federal healthcare fraud prosecutions.

5 Reasons to Choose Oberheiden, P.C.’s Defense Lawyers for Your Federal Healthcare Fraud Investigation in San Francisco

If you, or someone within your business or practice, has been contacted by the Department of Justice (DOJ), Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), Internal Revenue Service (IRS), Office of Inspector General (OIG), or any other federal law enforcement agency, it is imperative that you engage legal counsel immediately. Here are five reasons why healthcare providers in San Francisco and nationwide trust the defense lawyers at Oberheiden, P.C.:

  • Thousands of Federal Cases Handled – Our attorneys have handled thousands of federal cases. This includes not only our experience as defense attorneys, but also many of our attorneys’ past experience as federal healthcare fraud prosecutors with the DOJ.
  • Proven Pretrial Results – We have resolved the vast majority of our clients’ cases prior to trial, often without charges ever being filed.
  • Aggressive and Strategic Representation – Once we intervene in the government’s investigation, we do not stop applying pressure until we have achieved our desired result. We provide aggressive and strategic representation, and we are constantly looking for the leverage and evidence we need to protect our clients.
  • Unwavering Commitment to Favorable Outcomes – We want the best for our clients, no matter what. We are passionate about what we do, and we are committed to our clients’ best interests.
  • Meticulous Trial Preparation – If it takes going to court to protect you, you can rest assured that our San Franciso federal healthcare fraud defense lawyers will be meticulously prepared. We are skilled litigators, and we have relationships with top medical experts around the country.

Frequently Asked Questions

What is a whistleblower claim?


The term whistleblower refers to an individual who brings evidence of healthcare fraud to the attention of federal authorities, usually in hopes of securing a financial reward for themselves. Under the qui tam provision of the False Claims Act, anyone with knowledge of potential healthcare fraud is permitted to bring a case themselves on behalf of the government. As soon as a whistleblower, also called a relator, provides information to the government, the government must follow up on the allegations. If it finds the allegations are both significant and supported by evidence, the government may decide to intervene in the case. However, even if the federal government chooses not to intervene, the whistleblower can pursue the case at their own expense. If you recently learned that a whistleblower brought allegations of healthcare fraud against you or your practice, contact an experienced San Francisco federal healthcare fraud defense attorney as soon as possible.

Do I need to worry about a whistleblower who came forward with allegations of healthcare fraud?


It is easy to write off a whistleblower’s allegations as self-serving because they stand to receive a portion of any amount recovered through a healthcare fraud action. However, it is important you practitioners and management teams take these allegations seriously, as they can—and often do—result in significant liability. Additionally, 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. However, even if the government does not intervene, the whistleblower may decide to proceed with the case on their own. Therefore, it is imperative that any healthcare provider reach out to an experienced San Francisco, California federal healthcare fraud defense attorney as soon as they learn about a whistleblower’s allegations.

What is a Civil Investigative Demand?


A Civil Investigative Demand (CID) is a legally enforceable document that seeks documents or other information related to an investigation. CIDs are one of the primary tools used by federal law enforcement and regulatory agencies when investigating claims of healthcare fraud. Federal agencies use CIDs to obtain information that may become the basis for future enforcement actions. If you receive a CID, it does not necessarily mean that you or your practice is under investigation; however, that possibility cannot be ruled out either. Thus, it is important not only that you respond to a CID but that you also carefully consider your response. If you are in receipt of a CID, contact a San Francisco federal healthcare fraud defense attorney to go over your options.

Speak with a San Francisco Federal Healthcare Defense Lawyer at Oberheiden, P.C.

If you need to speak with a member of our federal healthcare fraud defense team, please call 888-680-1745 or contact us online. You can reach us 24/7. And if a San Francisco federal healthcare fraud defense attorney is not available immediately, a member of our team will be in touch as soon as possible.

Additional Pages for San Francisco, California

All website terms, conditions, and disclaimers apply to this information and are hereby fully incorporated. Specifically, this information has been prepared (1) for informational purposes only and does not constitute legal advice; (2) This information may constitute attorney advertising in some jurisdictions; (3) Merely reading this information does not create an attorney-client relationship; (4) Attorneys of Oberheiden, P.C., are not licensed in all states but are only licensed to practice in the states mentioned in their respective biographies. Nothing contained in here is meant to constitute the unauthorized practice of law or a suggestion of physical presence in the state; (5) Prior results do not guarantee similar outcomes in the future.

Why Clients Trust Oberheiden P.C.

  • 1,000+ Cases Handled
  • Available Nights & Weekends
  • Experienced Trial Attorneys
  • Former Department of Justice Trial Attorneys
  • Former Federal Prosecutors, U.S. Attorney’s Office
  • Former Agents from FBI, OIG, DEA
  • Cases Handled in 48 States
Email Us Call: 888-680-1745