Cardiologists: The New Targets of Medicare Fraud Investigations
Oberheiden, P.C. Protects Cardiologists Against Unjust Allegations
Years ago, being a successful cardiologist was a sign of expertise. Today, if one wants to believe the government’s story, being a successful cardiologist means that you are under general fraud suspicion. Perhaps the biggest change in health care fraud and Medicare fraud investigations over the last decade has been the so-called data analysis approach by federal investigators. Instead of pursuing actual knowledge or reasonable suspicion of fraud, today, FBI investigators simply filter and compare. The busiest practices in a defined geographical area (sometimes a zip code, sometimes a city or a county) are automatically on the government’s radar.
Why Are Cardiologists On the Government’s Radar?
Cardiologists and cardiovascular surgeons, by virtue of the fact that they see a disproportionate high number of Medicare patients, have become prime targets of government audits and investigations. Already a cursory look at recent criminal indictments, whether in Cleveland, Houston, California, New York, or Florida, reveals a scary story. Hard working cardio-surgeons and members of well-respected cardiology groups have been indicted for health care fraud, Medicare program fraud, and related charges. The allegations in these cases are identical. The physicians in these cases were charged by a federal grand jury for ordering and performing unnecessary medical tests, in particular:
- Nuclear stress test
- Cardiac Catheterizations
- Bone Density Scans
- Carotid Artery Scans
- Venous Ultrasounds (Legs & Abdominal)
- Illegal Kickbacks
Additionally, the government claims that many of the tests billed for were in fact never provided. Other cardiology cases allege that certain symptoms that would establish medical necessity — like shortness of breath, hypertensions, palpitations, and other breathing abnormalities — were mere fabrications. Violations of the Controlled Substances Act for prescribing Percocet, Xanax, or Tramadol outside the ordinary course of medical practice are frequently added in recent indictments, consistent with the federal government’s hard take on controlled substances and opioids.
What You Need to Know If You Are a Cardiologist
- Many cases that end up as referrals to the U.S. Attorney’s Office for civil or criminal prosecution innocently start with an audit from a private insurance plans or a request for patient records from CMS. That’s the time when you need to hire experienced attorneys!
- The federal government extends its jurisdiction to commercial insurance plans.
- Federal prosecutors are well trained and instructed to seek maximum sentences in federal cases against cardiologists.
- Opioid prescriptions of any kind will cause red flags and should be administered with extra care and in strictest accordance with applicable rules.
- You may never get caught, but, if you do, the penalties can be severe and may include civil and/or criminal prosecution.
- The law does not require criminal intent to violate the federal False Claims Act. If your practice submits a claim that is false or wrong, you may be subject to prosecution.
- The best preemptive measure to protect your license and your practice is to coordinate a recognized corporate health care fraud compliance program. Contact Oberheiden, P.C. for details.
An Entire Team of Former Medicare Prosecutors Is Available to Help You
Oberheiden, P.C. is a nationally recognized health care fraud defense law firm. Featured by media stations and appraised by clients, our lawyers represent, advise, and defend cardiologists and cardiology groups against health care fraud investigations — utilizing decades of first-hand experience gathered from previously held positions at the Department of Justice.
- Former Justice Department Lawyers
- Former Federal Health Care Fraud Prosecutors from the U.S. Attorney’s Office
- Significant Experience with Health Care Fraud Cases
- Available, Including on Weekends
There truly is no firm like ours. Cardiologists and physician groups from across the United States trust our firm because of our focus on health care fraud defense and our track record of resolving even the toughest cases with no liability outcomes for our clients. We have avoided criminal or civil charges and served clients as:
- Alabama Health Care Fraud Defense Attorney
- Arkansas Health Care Fraud Defense Attorney
- California Health Care Fraud Defense Attorney
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- Indiana Health Care Fraud Defense Attorney
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- New Mexico Health Care Fraud Defense Attorney
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- Oklahoma Health Care Fraud Defense Attorney
- Oregon Health Care Fraud Defense Attorney
- Pennsylvania Health Care Fraud Defense Attorney
- Tennessee Health Care Fraud Defense Attorney
- Texas Health Care Fraud Defense Attorney
- Virginia Health Care Fraud Defense Attorney
- Utah Health Care Fraud Defense Attorney
- Washington Health Care Fraud Defense Attorney
If you or your practice is under government investigation or if you have questions about compliance for cardiologists, you speak to experienced lawyers.
Call today and speak to one of our distinguished attorneys, free of charge and with the knowledge that your conversation is confidential.
What Are Signs of a Government Investigation?
It is not always clear in the beginning of a case whether there actually is a case, what the case is about, and whether the case is civil or criminal in nature. The following events should alert you that something might not be right with your practice of medicine. Immediate attention of trusted and experienced counsel is recommended if you notice any of the following.
In the context of cardiologists, many investigations by the Office of Inspector General focus on alleged violations of the federal Stark Law or the Anti-Kickback Statute. Both statutes apply to physicians seeing Medicare patients. While the Stark Law statute (42 U.S.C. 1395nn) prohibits certain referrals from a physician to an entity in which the physician has a financial interest, the Anti-Kickback Statute civilly and criminally sanctions referrals that were made in exchange for unjustified remuneration. One way for the government to find out if these statutes were in fact violated is by way of OIG subpoenas. Such a subpoena requires the cardiology practice to produce specifically identified patient records, and often also corporate documents and communication logs.
Grand Jury Subpoena
Oberheiden, P.C. is increasingly hired to help cardiologists respond to a grand jury subpoena. From the outset, it is important to realize that the existence of a grand jury (whose job it is to determine whether to authorize felony charges) is an extremely alarming sign. What we see is that cardiology groups are targeted to produce extensive lists of patient records that are then being submitted to government experts for evaluation. Purpose of the record review is to establish that nuclear stress tests and other expensive cardio procedures were not medically necessary and therefore fraudulent. In most cases, the physician owners of the P.A. or the physician group are declared criminal targets of the investigation.
Attorney: Virtually all lawyers at Oberheiden, P.C. have significant experience with the grand jury process, some of our lawyers have handled or supervised many hundreds of grand jury proceedings as state and federal prosecutors. When it comes to representing clients in a grand jury case, the slightest mistake can turn a potential witness into a target. Recipients of a federal grand jury subpoena should contact our former chief coordinator for criminal health care fraud to learn about the process and the appropriate and proven avenues to avoid or defend charges against the individual doctors.
Federal Arrest & Indictment
Criminal charges against cardio specialists are real and if this has happened to you, we encourage you to contact us immediately to explore reasons for the arrest (e.g. allegations of medically unnecessary procedures, opioid prescriptions, billing fraud) and ways to a fight the charges.
Attorney: If you were arrested, you do not need a criminal attorney; you also don’t need a health care lawyer. What you really need is a health care fraud defense attorney, an experienced federal criminal defense lawyer that understands all aspects of health care law and that is familiar with cardiology practices and testing. A number of attorneys at Oberheiden, P.C. qualify for this high standard. Several of our team members have all handled large number of fraud indictments and can navigate you through the process to ultimately protect your license and your livelihood.
If you are or if you think you are under investigation, you should immediately seek professional guidance. Oberheiden, P.C. provides free and confidential consultations, including on weekends, to discuss your situation and to find a way to avoid or fight a government’s case.
Contact Experienced Health Care Fraud and CMS Audit Defense Lawyers for Cardiologists
Oberheiden, P.C. is easy to contact. Just call our office number and speak directly to one of our experienced attorneys, or contact us online. No junior lawyers and no secretaries will deny or delay your access to important information about your case.