Colorado Health Care Fraud Defense
Experienced Health Care Fraud Defense Lawyers Representing Medical Providers in Colorado
United States citizens demand accountability from individuals, firms, and businesses who abuse government programs such as Medicare and Medicaid as well as those who attempt to defraud the federal government. Employees with federal agencies such as the Federal Bureau of Investigation (FBI), the United States Department of Justice (USDOJ), the Drug Enforcement Administration (DEA), are tasked with investigating and prosecuting those Colorado-based health care providers and individuals who are suspected of engaging in fraudulent activities.
Physicians, health providers, and others in the health care industry who operate in the Colorado area should take measures that will help protect you in the event a federal health care fraud investigation is initiated against you or your business. This includes ensuring that you have access to experienced and knowledgeable legal counsel.
Contact the Former U.S. Prosecutors of Oberheiden, P.C.
When you and/or your business is the target of a federal health fraud investigation, you need the advice and representation of Oberheiden, P.C.. Our firm is comprised of former DOJ and federal officials who are intimately familiar with federal health fraud investigations and audits. In fact, our firm and its personnel have participated in over 1,000 health care fraud investigations and audits. While we are proud of our firm’s past successes, we are not tied to them: we utilize our knowledge of what has worked for our clients in the past to develop new and innovative ways to better represent and defend you and your business.
Oberheiden, P.C.’s Experience Incorporates:
- Over 1,000 health care investigations alleging fraud
- Over 1,000 grand jury proceedings
- Countless federal and state criminal indictments dismissed
- Over 500 criminal trials
- Over 70 years of combined Department of Justice experience
Current Fraud Investigations in Colorado
The Drug Enforcement Administration, the Office of the Inspector General, and the Federal Bureau of Investigation are just some of the federal agencies that have conducted – and are presently conducting – investigations targeting Colorado health providers and related enterprises. Violations of the Anti-Kickback Statute (42 U.S.C. 1320a-7b), the Stark Law (42 U.S.C. 1395nn), the Controlled Substances Act (21 U.S.C. 841, 846), and other similar statutes can result in significant civil penalties and, in some cases, serious criminal consequences.
Audits & Compliance:
- Medicare Audits & ZPIC Audits. Medicare Administrative Contractors (MACs) and Recovery Audit Contractors (RACs) are tasked with detecting payments made on claims that are either improper or outright fraudulent. They do this by analyzing data from claims submitted to Medicare and comparing the data contained in the claim to information and documentation supplied by the health provider. Furthermore, Zone Program Integrity Contractors (ZPICs) audits are also tasked with uncovering potentially fraudulent activity and referring such activity to the Department of Health and Human Services (HHS) and/or the Office of the Inspector General (OIG). These audits are supposed to be conducted by trained and objective professionals: however, mistakes in the manner in which these audits are conducted can happen. When they do, you and/or your business may face criminal charges from the United States Attorney’s Office. At Oberheiden, P.C., former DOJ prosecutors use the knowledge and training they obtained working for federal authorities to help clients complete these and other government audits quickly and with as little disruption to their businesses as possible.
- False Claims Act Violations. One of the more common statutes enforced against health care providers and others in the health care industry is the False Claims Act, or FCA. Violations of the False Claims Act typically occur when “false and fraudulent” claims for payment are submitted to government programs such as Medicare, Medicaid, and Tricare. It is not necessary for the “false and fraudulent” claim to be submitted with knowledge or intent to deceive in order for a violation of the False Claims Act to be found. A violation of the False Claims Act can result in civil fines and other penalties as well as criminal sanctions as well. If you or your business has been notified by the Office of the Inspector General that you are the subject of a False Claims Act investigation, contact Oberheiden, P.C. right away. We have successfully represented clients throughout the United States who were also the subject of an FCA investigation.
- Physician “Self-Referrals” and Stark Law Violations. The Stark Law prohibits doctors from referring patients to a “related” health care provider or business so that the doctor receives a financial benefit. You and your business may be heavily sanctioned if it is determined that you violated the Stark Law. The team at Oberheiden, P.C. can help you defend yourself, your reputation, and your livelihood against these types of allegations.
- Colorado Billing / Coding Mistakes. Medical billing can be complicated for large hospitals and solo health providers alike. Errors in billing or coding for services such as billing for procedures and treatments that are not medically necessary, upcoding a procedure or treatment so that it is compensated at a higher rate, or billing for procedures and services that were not actually provided to the patient can lead to civil and/or criminal penalties.
- Health Care Fraud & Conspiracy to Commit Fraud. Under Title 18 U.S.C. Section 1347, health care fraud is defined as executing or attempting to execute a scheme or plan designed to defraud a “health care benefit program” or to obtain “any of the money or property owned by, or under the custody or control of” a health care benefit program through false representations. Successful prosecutions can lead to hefty fines and/or up to ten years in federal prison. These penalties may be visited upon you and your business – even if you yourself did not actually make any such deceptive representations – if federal prosecutors can show you conspired with another person or business who did make fraudulent representations. Our firm zealously defends clients charged with health fraud charges and conspiracy charges. Our attorneys’ experience in working for the Department of Justice and other federal agencies gives them “inside knowledge” on how the government will build its case against you – and how that case can be defeated.
- Prescription Drug & Opioid Abuse. With federal authorities declaring a national opioid abuse epidemic, now more than ever pharmacies, pharmacists, and doctors who prescribe and dispense opioids and other prescription drugs are having their practices heavily scrutinized. Investigations can be initiated if prescription drugs are dispensed incorrectly or if opioids are prescribed to patients with a history of opioid abuse, for example. Oberheiden, P.C. is able to quickly intervene on behalf of health care providers who find themselves accused of improper handling or dispensing of prescription drugs and/or opioid medications.
- Medicare Fraud and Medicaid Fraud. Intentionally defrauding or attempting to defraud the Medicare or Medicaid programs will almost certainly attract the attention and interest of federal investigators and prosecutors. Practices such as fraudulently coding or billing for services, submitting fraudulent credentials that purport to show a provider is qualified to perform a particular service (when, in fact, the provider is not) and seeking compensation for treatments and services that are not actually provided. If you discover that you and/or your practice are being investigated for Medicare or Medicaid fraud, contact our firm as soon as possible. Our firm has a solid history of assisting clients charged with these serious allegations in successfully resolving their civil and/or criminal matters. In some cases, we have been able to resolve our clients’ fraud charges without our clients being found guilty of committing a crime or having to pay any civil fines at all.
- Illegal Kickbacks, Bribes, and Referral Fees. Unlike some federal health care statutes that prohibit certain conduct committed by doctors or other health providers, the Anti-Kickback Statute applies to any Under the statute, a person who offers, solicits, pays, or receives compensation in exchange for a patient referral is subject to penalties and sanctions described in the Anti-Kickback Statute. This statute can be particularly problematic for doctors’ offices, hospitals, and other similar businesses and practices that have a business relationship with certain laboratories and pharmacies. Our experienced legal team is well-familiar with the Anti-Kickback Statute along with the statutes exceptions, and can thereby provide you and your business with a winning defense.
At Oberheiden, P.C., we are eager to talk about your circumstances and worries through a free, confidential, and no-obligations consultation. During your free consultation, we will review with you the facts of your specific situation and inform you of how we can help you resolve your situation efficiently and successfully. Learn the difference that hiring a health care fraud defense firm with over 70 years’ combined previous experience working for federal authorities can make in your case. Call our firm and schedule your free initial consultation today.
FAQs: What Colorado Providers Need to Know about Health Care Fraud Investigations
Q: What health care providers are being investigated in Colorado?
No health care provider in Colorado should assume that he or she could never be the subject of a federal Colorado health care fraud investigation. A careless mistake or inadvertent error can catch the attention of federal auditors and investigators and cause an investigation or criminal prosecution to commence. As a result, the following health providers and related entities should strongly consider retaining the services of Oberheiden, P.C.:
- Pharmacists and pharmacies;
- DNA testing facilities;
- Toxicologists and toxicology laboratories;
- Marketing agencies;
- Home health care and hospice businesses;
- Hospitals and outpatient surgical centers; and
- Drug rehabilitation facilities
Q: What coding and/or billing errors lead to health care fraud investigations?
Because of the perception that Medicare, Medicaid, and other federal health benefits programs are rife with fraud and abuse, the federal government now devotes a considerable amount of resources to ferret out those who commit fraud against these programs. Coding and billing errors and mistakes are a common way by which auditors and investigators learn of fraudulent schemes. Some of the many types of errors and mistakes these federal agents are trained to look for include:
- Double-billing, where two or more federal health care benefits programs are billed for the same service or procedure;
- Billing for treatment and procedures that are not actually rendered to the patient;
- Submitting claims for treatment and procedures that are not permitted under the regulations of the benefits program or that are not medically necessary.
Q: How can I protect myself and/or my practice from allegations of prescription drug fraud or abuse?
Because of the current opioid abuse epidemic plaguing the country, those who prescribe medications as well as the pharmacists and pharmacies that fill those prescriptions are under intense scrutiny from the Department of Justice, the Drug Enforcement Administration, and other federal agencies. Being accused of prescription drug fraud or abuse can jeopardize your financial resources, your license, your reputation, and even your freedom. Some of the activities and practices that lead to investigation and prosecution include:
- Failing to follow laws and regulations regarding electronic or traditional prescriptions;
- Prescribing medications – especially opioids – to patients with a history of drug abuse or addiction;
- Prescribing medications to patients where there is no medical necessity for the medication;
- Prescribing medications for medical conditions that the drug is not approved to treat.
Q: What sanctions are permitted for those found guilty of health care fraud?
In the past, health care fraud was primarily handled through the civil court system. Successful prosecutions would result in fines and sanctions along with the suspension or revocation of professional licenses. Now, these allegations often lead to criminal prosecution. Not only do criminal prosecutions carry with them the same potential for fines and license suspension/revocation, but incarceration for a period of years in a federal prison is also a possibility. This is why it is critical for physicians, pharmacists, hospitals, and other health providers to treat fraud investigations and allegations seriously. Oberheiden, P.C. can assist you and your practice or business in responding effectively to allegations of health care fraud. We draw upon our years of experience to create a custom-tailored defense strategy designed to minimize – or avoid entirely – the potential consequences of a health fraud conviction.
Q: What other steps can I take to safeguard myself and my practice from health care fraud investigations and prosecutions?
Speak with the dedicated legal team at Oberheiden, P.C. to learn about how we can help you avoid being the target of a health care fraud investigation. Even if an investigation has already been initiated against you, we may be able to assist in resolving your matter quickly.
Oberheiden, P.C. is skilled in handling complex health fraud investigations and criminal cases. We have defended clients charged with Medicare or Medicaid fraud, violations of the False Claims Act, Stark Law-related offenses, and many other similar charges in Colorado and across the nation. Call us today and discuss your case with us.
Why Colorado Physicians, Dentists, Psychologists and Business Owners Choose Oberheiden, P.C.
There are many reasons to turn to Oberheiden, P.C. when you and/or your practice are facing charges stemming from violations of health care fraud statutes. Our clients choose us because we offer:
- Experience as former federal health fraud prosecutors, which gives us a unique insight into how the government will build and present its case;
- Proven results with many of our clients’ cases resulting in no civil or criminal liability for our clients;
- Attorneys who are familiar with federal laws pertaining to health care fraud; and
- A collaborative approach that draws on our legal teams vast and varied background to craft a successful approach to handling your case.
Do not gamble with your and your practice’s future: seek immediate legal help from Oberheiden, P.C. if you are being investigated for health care fraud. Without prompt legal intervention, you may find your way of life, financial future, and very freedom and liberty at risk.
Oberheiden, P.C. handles health fraud cases from clients all over the United States. Our attorneys’ backgrounds as former health care fraud prosecutors with the Department of Justice and other similar agencies mean that we are usually able to provide superior results for our clients in less time.
Our approach to our clients’ cases is unique to each client: what works for one client’s case may not work for your case. However, one of our guiding principles is that we believe it is important to be proactive – not reactive. We actively challenge the government’s case and evidence so your case can be resolved as quickly as possible. We also:
- Will make immediate contact with government investigators and prosecutors assigned to your case so we can obtain the information they have and begin formulating your defense strategy;
- Ensure the correct legal standards and laws are being applied correctly to your case;
- Work with you to craft a customized defense strategy based on the nature of the evidence against you, the allegations made against you, and the goals you have;
- Strive to protect your reputation and preserve your and your business’s tangible and intangible assets; and
- Go to trial when necessary. Our law firm has handled over 500 criminal cases, meaning we are able to protect your interests both inside and outside of the courtroom.