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San Jose Healthcare Fraud Defense Lawyers

Healthcare fraud allegations are causing many San Jose practitioners and business owners to face severe consequences in high-stakes federal investigations. If your practice or business is under investigation for healthcare fraud, it is important that you speak with our San Jose healthcare fraud defense lawyers promptly.

San Jose Healthcare Fraud Defense Lawyers

From overbilling Medicare and Medicaid to improperly providing access to opioid medications, healthcare providers in San Jose and around the country are facing a litany of allegations in federal investigations. These allegations have the potential to cause long-term damage, even if they do not ultimately lead to federal charges. From reputational harm to licensing action by state medical boards, there are a variety of ways that healthcare fraud allegations can cause devastating consequences, even without fines or prison time.

At Oberheiden, P.C., we provide skilled and aggressive legal representation for federal healthcare fraud investigations in San Jose, California. We focus our practice on representing healthcare providers and medical businesses in federal investigations, and we have achieved favorable outcomes at all stages from investigation through appeal. In our experience, most investigations targeting legitimate healthcare providers are misguided in some way. Whether the allegations against you are completely unwarranted or you are being unfairly targeted for criminal (as opposed to civil) prosecution, we can use our experience to strategically defend you and seek a favorable outcome as quickly and discreetly as possible.

If your practice or business is under investigation for healthcare fraud, there are steps you need to be taking in order to minimize your risk for federal prosecution. The San Jose healthcare fraud defense attorneys on our healthcare fraud defense team can guide you through everything you need to know, and we encourage you to contact us promptly for a free and confidential consultation.

Understanding Healthcare Fraud Allegations

Under federal law, “healthcare fraud” is a general term that describes a broad array of civil and criminal allegations. While there is a federal healthcare fraud statute, 18 U.S.C. 1347, healthcare fraud can take a variety of other forms and be prosecuted under a variety of other statutes as well. For example, we routinely represent healthcare providers and medical business owners who are facing federal investigations based upon allegations such as:

  • Medicare, Medicaid, and Tricare coding violations (“billing fraud”)
  • Department of Labor (DOL) fraud
  • Providing and billing for medically-unnecessary services
  • Billing for services not actually rendered to patients (or “phantom billing”)
  • Unlawful “kickbacks” or referral fees (Anti-Kickback Statute violations)
  • Unlawful physician “self-referrals” (Stark Law violations)
  • Prescription drug fraud (Controlled Substances Act violations)
  • Falsifying patient records, prescriptions, physician certifications, and election statements

Regardless of the specific allegations against you and regardless of how accurate or inaccurate you believe they may be, you need to take them extremely seriously. Your investigation is not simply going to go away on its own. To have any chance of avoiding federal prosecution (possibly even criminal prosecution with the potential for long-term federal imprisonment), you need to mount a strategic and effective defense.

When we represent healthcare providers and medical business owners in federal fraud investigations, we emphasize being as proactive and aggressive as possible. The reason for this is simple: If we can resolve your case at the investigative stage, you will not face charges and you will not face the inherent uncertainty of taking your case to trial. In order to protect you, contact a  San Jose healthcare fraud defense lawyer.

  • Intervene in the investigation to determine the scope and nature (i.e., civil or criminal) of the allegations against you;
  • Advise you and your personnel on how to deal (or not deal) with federal agents and other mistakes to avoid;
  • Strategically assert affirmative defenses that challenge the underlying basis of the government’s investigation; and
  • Challenge the government’s methods and assumptions in order to convince prosecutors that charges are not warranted.

Experienced San Jose Healthcare Fraud Defense Attorneys for All Healthcare Fraud Matters

With our extensive experience on both sides of federal healthcare fraud investigations (several of our defense attorneys are former prosecutors with the U.S. Department of Justice (DOJ)), we have handled cases involving all types of fraud-related allegations. This includes allegations under:

1. The False Claims Act

The False Claims Act (FCA) imposes civil and criminal penalties for the submission of “false or fraudulent” claims for federal healthcare program reimbursement. This includes all forms of billing violations, including upcoding, unbundling, phantom billing, and billing for medically-unnecessary services and supplies. Civil penalties under the FCA include recoupments, civil assessments, fines, and program exclusion, while criminal violations (those committed with “intent”) carry fines and prison time.

2. The Anti-Kickback Statute

The Anti-Kickback Statute (AKS) prohibits the offer, payment, solicitation, and receipt of referral fees and all other forms of “remuneration” in connection with referrals for Medicare, Medicaid, Tricare, and DOL-reimbursed healthcare services. Like the False Claims Act, the AKS has provisions for civil and criminal penalties, with intent being the distinguishing factor between civil and criminal liability.

In federal healthcare fraud investigations under the Anti-Kickback Statute, a key defense strategy is often to establish protection under one of the statute’s “safe harbor” provisions. The AKS includes safe harbors for:

  • Bona fide employment relationships
  • Discounts
  • Group purchasing organizations
  • Investment Interests
  • Management contracts
  • Office and equipment rentals
  • Personal service arrangements
  • Practitioner recruitment
  • Price reductions
  • Referral services
  • Sale of healthcare practice
  • Waivers of copayments, coinsurance, and deductibles
  • Warranties

3. The Stark Law

The Stark Law prohibits so-called “physician self-referrals.” It is exclusively a civil statute. However, even in civil cases, physicians and their “related entities” can face substantial financial liability and loss of Medicare and Medicaid eligibility. Similar to the Anti-Kickback Statute, the Stark Law contains broad prohibitions that are tempered by a list of statutory and regulatory exceptions. If an exception applies in your case, our skilled San Jose healthcare fraud defense attorney can use this to protect you against prosecution.

4. The Controlled Substances Act

The Controlled Substances Act is one of the primary federal statutes used to prosecute healthcare providers who commit pharmaceutical fraud. This includes overbilling for prescriptions, billing for medically-unnecessary prescriptions, forging and falsifying prescriptions, improperly filling prescriptions, and providing opioid medications to drug-dependent individuals. The Controlled Substances Act includes substantial criminal penalties, and healthcare providers and medical business executives targeted under the Controlled Substances Act must be prepared to vigorously defend themselves.

5. The 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.” Violations of 18 U.S.C. 1347 carry fines and up to 10 years of imprisonment in most cases, with longer terms (20 years to life) for violations resulting in serious bodily injury or death.

6. Program Billing Regulations

Healthcare providers who violate Medicare, Medicaid, Tricare, and DOL billing regulations can face prosecution under the False Claims Act, 18 U.S.C. 1347, and various other federal laws. Under the civil enforcement provisions of many of these laws, providers can be penalized if they “should have known” of the submission of an improper claim or claims.

7. Other Federal Criminal Laws

In criminal healthcare fraud investigations, providers and company owners and executives can (and often will) face charges for multiple offenses, not simply those that are healthcare related. This includes charges for attempt, conspiracy, bank fraud, mail and wire fraud, money laundering, tax evasion, and various other white-collar crimes.

Trusted San Jose Healthcare Fraud Defense Lawyers

With centuries of combined legal experience in federal healthcare fraud investigations, Oberheiden, P.C.’s healthcare fraud defense attorneys are trusted advocates for licensed healthcare providers, business owners, company executives and board members, and other clients in civil and criminal matters. Here is what you can expect when you engage our healthcare fraud defense team to represent you in San Jose, CA:

  • Proactive and aggressive legal representation focused on securing a prompt and favorable resolution.
  • Defense strategies backed by experience in more than 1,000 investigations.
  • Unwavering commitment to your best interests and a client-first approach in all aspects of your representation.
  • Direct access to your team of senior healthcare fraud defense attorneys (we do not employ any junior associates or paralegals).
  • Personalized case strategies that utilize the facts and circumstances of your investigation to protect you against long-term consequences.

Frequently Asked Questions

What is the False Claims Act?


The False Claims Act is a federal law that prevents healthcare providers from overcharging federal programs due to false, fraudulent, or exaggerated billing practices. The civil False Claims Act imposes civil liability on any person who knowingly submits, or causes the submission of, a false or fraudulent claim to the Federal Government. Notably, there is no requirement that you intended to violate the False Claims Act. Additionally, a violation of the False Claims Act can result in criminal liability in some situations. If you are under investigation for a violation of the False Claims Act, it is important to take the allegations seriously, even if you are certain you didn’t do anything wrong. To learn more about the False Claims Act and how you can defend against the allegations, contact a San Jose, California federal healthcare fraud defense attorney.

What is a whistleblower lawsuit?


Under the False Claims Act, a private citizen who believes they have evidence of healthcare fraud can bring a private lawsuit against the practice or provider alleged to have committed fraud. Whistleblowers can be anyone, ranging from former employees to patients to other providers. When a whistleblower brings a healthcare fraud case, they will often approach federal investigators first to see if the government wants to intervene in the case. Whether the government decides to intervene will depend on the seriousness of the allegations and the factual support offered by the whistleblower. However, even if federal investigators decide not to intervene, the whistleblower can still proceed with the case on their own. If a whistleblower’s case ends in a finding of fraud, they are entitled to portion of any amount recovered, up to 30 percent. While allegations raised by a whistleblower are inherently suspect, given the financial incentives involved, these cases must be taken seriously. To learn more about whistleblower claims under the False Claims Act contact a San Jose, CA federal healthcare fraud defense attorney.

Which providers are most at risk for a healthcare fraud investigation?


The federal government oversees all healthcare providers, and no type of provider is immune from healthcare fraud charges. Generally speaking, the more volume a practice handles ––and the more successful it is–– the higher the chances of experiencing federal scrutiny. If you own or operate any of the following practices, it is in your best interest to contact a California federal healthcare fraud defense attorney as soon as you learn of an investigation:

  • DNA testing facilities
  • Drug rehabilitation facilities
  • Healthcare marketing agencies
  • Home healthcare agencies
  • Hospice providers
  • Hospitals
  • Mobile healthcare clinics
  • Outpatient surgical centers
  • Toxicologists and toxicology laboratories

Schedule a Free Initial Consultation at Oberheiden, P.C.

Is your healthcare business or medical practice under investigation in San Jose, CA? If so, we strongly encourage you to schedule a free initial consultation with our healthcare fraud defense team. You can reach us 24/7; if necessary, our San Jose healthcare fraud defense attorneys can get to work on your case immediately. To learn more about how we defend healthcare providers in federal fraud investigations, call 888-680-1745 or get in touch online now.

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