Southern CA Healthcare Fraud Defense Lawyer
Proven Southern CA Healthcare Fraud Defense Lawyers
If you or your medical practice are among the many targets of a federal healthcare fraud investigation in Southern California, you need our experienced Southern CA healthcare fraud defense attorneys at Oberheiden, P.C.
The federal government is executing a nationwide crackdown on healthcare fraud and other healthcare-related crimes such as drug diversion. While new cases are arising all over the country, Southern California has been one of the primary areas of focus for several major federal agencies, including the Drug Enforcement Administration (DEA) and the Department of Health and Human Services’ Office of Inspector General (DHHS – OIG).
Oberheiden, P.C., is a federal defense law firm. Contact a Southern CA healthcare fraud defense attorney who represents healthcare professionals, corporate officers, owners, and business entities in both civil and criminal investigations in Southern California.
Our attorneys have more than 100 years of combined legal experience, much of it concentrated in federal healthcare fraud. Several of the attorneys in our office spent years or decades as senior federal prosecutors, and our Southern CA healthcare fraud defense attorney have extensive experience in negotiating directly with agencies like the DEA, OIG, and FBI. We use that insight to help our clients make wise decisions and avoid unnecessary consequences during a federal healthcare fraud investigation.
Please do not underestimate the seriousness of a federal investigation, the danger of interacting with federal agents, or the severity of a formal allegation (let alone conviction). Hire an experienced team of defense veterans to protect you. Contact Oberheiden, P.C., and ask to speak with a healthcare fraud defense attorney for Southern CA today.
What Is Healthcare Fraud?
The United States criminal code contains a surprising number of statutes aimed directly at the healthcare industry. They are used to put otherwise respected white-collar professionals (such as business owners, nurses, and physicians) in prison for many years for non-violent crimes. Our highly experienced Southern California healthcare fraud defense lawyers will review some of those specific statutes in the next section. But at the outset, it should be noted that the term “healthcare fraud” is something of a catch-all phrase. It may refer to any number of federal offenses or specific sections of the U.S. code. Accordingly, there are many ways to commit “healthcare fraud.”
When we enter a case, one of our first priorities is to determine two key, preliminary pieces of information:
- The nature of the investigation (is it civil or criminal?)
- The specific agencies and/or task forces involved
Those two items tell us a lot about what’s happening, what’s at stake, and how we should respond for our clients. Different agencies have different priorities when it comes to healthcare fraud enforcement. The DEA, DOJ, and the Office of the Inspector General of the Department of the Health and Human Services (DHSS – OIG) are among the primary investigators of healthcare fraud in Southern CA.
Some of the healthcare fraud allegations that our California healthcare fraud defense attorneys have defended against at Oberheiden, P.C., include:
- Billing fraud (Medicare, Medicaid, Tricare, etc.)
- Department of Labor (DOL) fraud
- Anti-Kickback Statute violations
- Stark Law violations (physician self-referral)
- Controlled Substances Act / DEA registration violations (including prescription drug fraud)
- Providing / Billing for medically unnecessary services
- Billing for services not actually rendered to patients
- Falsifying patient records, prescriptions, physician certifications, or election statements
The Most Commonly Invoked Healthcare Fraud Laws
Below, we review just a handful of the most common statutes, laws, regulations, and directives that result in the criminal prosecution of healthcare professionals in Southern California.
1. The False Claims Act
The False Claims Act (FCA) is one of the most well-known healthcare fraud statutes. It prohibits the submission of “false or fraudulent” claims for payment to any federal benefits program. In most cases, the FCA is invoked in billing discrepancies with Medicaid, Medicare, or Tricare. The law applies to anyone who submits payment claims to these or other benefits programs. This includes not only physician’s groups or hospitals, but also many medical supply companies, ambulance operators, mobile health companies, and other entities. FCA penalties are applied per claim, so the toll of each fine and reimbursement can quickly add up to an effectively unpayable sum. Additional consequences of FCA violation can include exclusion from federal benefits programs and/or prison sentences.
2. The Anti-Kickback Statute
When is a mutual marketing arrangement a crime? More often than you might think, thanks to the Anti-Kickback Statute (AKS). This statute makes it a crime to offer, solicit, pay for, or receive a referral fee (or any other form of “remuneration”) in exchange for referring a Medicare, Medicaid, Tricare, or DOL beneficiary. AKS violations may result in civil and/or criminal penalties, depending on the circumstances.
3. The Stark Law
Under the federal Stark Law, it is illegal for physicians to engage in so-called “self-referral.” While many providers understand this basic concept, you may be surprised to find yourself accused of violating the Stark Law when you had no idea you were “self-referring.” For example, a doctor may stand accused of breaking the Stark Law for unwittingly referring a patient to a business that the doctor has a distant or tenuous financial relationship with. Our federal defense attorneys are available to assist physicians or entities accused of Stark Law violations in Southern CA.
4. The Controlled Substances Act (CSA)
The Controlled Substances Act is a complex and multifaceted statute that establishes a regulatory system while also providing various criminal penalties – many of which are extremely and excessively harsh. The CSA is what gives the Drug Enforcement Administration much of its authority. Remember: the DEA isn’t just a regulatory organization; it is a law enforcement agency too. Common allegations made under the CSA include: prescribing medications unnecessarily, providing addictive drugs to patients with a history of abuse, misappropriating prescription substances, “selling” prescriptions, pharmaceutical fraud, and other unlawful practices.
5. The Federal Healthcare Fraud Statute
Referred to generally as “the healthcare fraud statute,” 18 U.S.C. 1347 makes it a crime to:
“knowingly and willfully execute, or attempt to execute, a scheme or artifice –
(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.”
Congress designed the healthcare fraud statute to give prosecutors and investigators wide breadth and authority. Accordingly, it is a useful tool to federal prosecutors in Southern CA who have been directed to amplify their efforts against healthcare providers.
6. Other Fraud Statutes
A healthcare fraud indictment often lists other, non-industry-specific charges, too. Wire fraud, mail fraud, bank fraud, and money laundering are common examples. Prosecutors are prone to building healthcare conspiracy cases as well, such as “conspiracy to commit healthcare fraud.”
7. Program Billing Regulations
Agencies like the CMS are authorized to propagate their own billing regulations, which carry the force of law. Whereas most fraud cases require proof of intent, when it comes to federal program billing regulations, even an unintentional violation can lead to criminal penalties (or civil recoupment actions, often adding up to millions of dollars). These often come about as a result of a routine audit or investigation. For this reason, Southern CA care providers should set up a proactive compliance program to mitigate the risk of prosecution.
8. DOJ Mandates
The DOJ frequently issues press releases and/or directives, which tell DOJ operatives how to prioritize their efforts. Currently, the DOJ has mandated that healthcare fraud and opioid fraud and abuse be made national priorities. That is reflected in the recent launch of both the Prescription Interdiction & Litigation (PIL) Task Force and the Opioid Fraud and Abuse Detection Unit within a matter of months. These new efforts, combined with the existing Medicaid Fraud Strike Force office in Los Angeles, are now responsible for many of the healthcare arrests in Southern California.
5 Reasons to Trust Oberheiden, P.C., as a Federal Healthcare Fraud Defense Firm for Southern CA
Here are five reasons why healthcare providers and other Medicare, Medicaid, and Tricare participants should choose Oberheiden, P.C., as their Southern California federal healthcare fraud defense attorney:
- Our Extensive Experience in Healthcare Fraud Investigations – We have handled thousands of federal healthcare fraud audits, investigations, and prosecutions on behalf of healthcare providers in Southern CA and nationwide.
- Our Record of Avoiding Charges – In the majority of our cases, our Southern CA healthcare fraud defense lawyers have reached a resolution in which the client did not have to face any criminal charges.
- Our Focus on Federal Healthcare Fraud Defense – Much of our defense work over the years has been in the highly specific area of federal healthcare fraud defense. We have represented physicians, pharmacists, clinics, laboratories, hospitals, hospices, and virtually all other types of healthcare provider.
- Our Experience on Both Sides – Oberheiden, P.C., is comprised of both long-established federal defense attorneys and deeply experienced former federal prosecutors. We believe this “dual perspective” is of tremendous benefit to our clients.
- Our Aggressive Defense Strategies – Our Southern CA healthcare fraud defense attorneys take an aggressive approach to representing our clients. Our law firm has been intentionally designed so that we can quickly and cost-effectively develop custom-tailored defense strategies for our clients, even on an emergency basis as needed.
Don’t make the mistake of facing the federal criminal justice system on your own. Choosing the right law firm could become the most important decision you will ever make.
FAQs About Healthcare Fraud in Southern California
What statutes and regulations do the federal government use when pursuing healthcare fraud?
While a range of legal tools could be used by federal prosecutors, the legal grounds for many cases seeking civil and criminal liability include:
- False Claims Act (FCA): The federal government has many statutory tools to target healthcare fraud and other many other types of conduct that deplete public funds. However, the FCA bans knowingly presenting or causing to be presented fraudulent or false claims for payment by the federal government. The risk of well-meaning healthcare professionals and medical industry corporations being caught up in an FCA case is magnified because the statute authorizes lucrative rewards to so-called “whistleblowers.” The statute imposes penalties that include treble damages, financial penalties, and even potential criminal liability.
- Anti-Kickback Statute (AKS): This criminal statute forbids giving or offering compensation to attract the referral of Medicare/Medicaid business. Violations are punishable by up to five years imprisonment and a fine of $25,000.
- Stark Law: This statute prohibits a doctor from referring a Medicare patient to entities providing certain medical services in which the referring party has a financial relationship. A party found civilly liable under this statute must return any such payments. The law also authorizes civil penalties up to a maximum of $15,000 per service.
- Criminal Healthcare Fraud Statute: This law authorizes criminal liability for intentionally defrauding a healthcare benefit program or making false statements for such a purpose. The sentence for a conviction can include ten years imprisonment and a fine of double the amount at issue or a $500,000 fine.
When is prescription drug diversion considered a federal crime?
Putting prescription drugs in the hands of patients (or non-patients) who don’t need them is a federal offense. The federal laws governing the prescription and administration of controlled-substance medications are extremely strict, and physicians, pharmacists, and other providers can face federal charges for practices including:
- Prescribing medically-unnecessary medications
- Selling prescriptions
- Providing prescription medications to non-patients or without an in-person exam
- Over-filling or under-filling prescriptions
- Forging prescriptions
What should I do if I am aware of improper billing practices or other unlawful activity?
If you are aware of improper billing practices or other unlawful activity, you need to be extremely careful. You need to avoid engaging in conduct that could lead to additional charges or penalties. However, you also need to avoid tipping off federal agents and prosecutors that you are aware of a situation that needs to be remedied. Our California federal criminal defense attorneys can guide you through what you need to do, step-by-step.
What penalties could I be facing as the result of a federal criminal investigation?
The two primary types of penalties under federal law are fines and imprisonment. Most federal criminal statutes include provisions for substantial fines (typically in the tens or hundreds of thousands of dollars) and substantial terms of federal incarceration (years or decades behind bars). In federal investigations targeting healthcare providers, other direct and indirect consequences can include:
- Recoupments and denial of pending payments
- Pre-payment review
- Program exclusion (Medicare, Medicaid, and Tricare ineligibility)
Discuss Your Federal Healthcare Fraud Investigation in Confidence
If your Southern CA healthcare practice or company is being targeted in a federal healthcare fraud investigation, we strongly encourage you to contact us for a confidential case assessment. To speak with our Southern CA healthcare fraud defense lawyer for free, call 888-680-1745 or inquire online, right away.