Department of Health and Human Services Fraud Defense
Our Senior Healthcare Fraud Defense Lawyers Have Decades of Experience on Both Sides of Investigations, Enforcement Proceedings, and Litigation Involving the U.S. Department of Health and Human Services (DHHS)
The U.S. Department of Health and Human Services (DHHS) is one of the primary agencies responsible for enforcing the nation’s healthcare laws. In this capacity, it focuses much of its effort on targeting healthcare providers and other entities and individuals suspected of defrauding Medicare, Medicaid, and other federal healthcare benefit programs. DHHS investigations targeting allegations of billing fraud and related offenses can lead to substantial penalties, and avoiding these penalties requires experienced legal representation.
At Oberheiden P.C., we have extensive experience representing healthcare providers and other clients in matters involving DHHS. As former healthcare fraud prosecutors with the U.S. Department of Justice, many of our senior attorneys also have extensive prior experience working with DHHS to uncover and prosecute instances of fraud. We rely on this experience to provide strategic and efficient defense representation for our clients, and we have been able to help our clients avoid liability entirely in many cases.
What Constitutes Department of Health and Human Services Fraud?
Allegations of Department of Health and Human Services fraud can take a variety of different forms. In recent years, however, DHHS has prioritized combatting fraud in four primary areas. These areas are: (i) contract fraud (ii) program fraud (including Medicare and Medicaid fraud), (iii) grant fraud, and (iv) fraud impacting residents of long-term care facilities.
1. DHHS Contract Fraud
The Department of Health and Human Services pays nearly $5 billion per year to government contractors. As a result, it maintains a heavy emphasis on combatting fraud, waste, and abuse. DHHS’s Office of Inspector General (OIG) investigates contractors for a broad range of fraudulent practices, including (but not limited to):
- Submitting fraudulent contract proposals
- Double-billing under multiple DHHS contracts
- Billing DHHS for items purchased for other clients
- Billing for expenses not actually incurred or work not actually performed
- Falsifying invoices and records
- Substituting inferior or unauthorized products
- Charging inflated rates
- Misrepresenting the current status of a project in order to continue receiving DHHS funds
- Offering bribes and other prohibited forms of compensation
These and other forms of fraud can lead to civil or criminal charges under the False Claims Act (among other federal statutes). If prosecuted under the False Claims Act, DHHS contractors can face penalties including fines, recoupments, and contract termination. In criminal fraud investigations under the False Claims Act, contractors’ owners and executives can also face the possibility of federal imprisonment.
2. DHHS Program Fraud (Including Medicare and Medicaid Fraud)
DHHS OIG investigates healthcare providers, clinics, laboratories, durable medical equipment (DME) companies and other entities and individuals suspected of fraudulently billing Medicare, Medicaid, and other federal benefit programs. Medicare and Medicaid fraud cost taxpayers billions of dollars per year; and, while much of this is attributable to intentional fraud schemes, DHHS targets legitimate program participants as well. A significant portion of our practice is devoted to representing physicians’ practices, hospitals, and other providers in DHHS program fraud investigations.
For providers and others facing DHHS program fraud investigations, it is imperative to engage experienced defense counsel immediately. You need to know what DHHS is going to find (if anything) that could lead to fraud allegations, and you need to be prepared to defend against any allegations that may arise. In most cases, executing a proactive defense strategy can significantly mitigate the risks involved in facing a DHHS program fraud investigation, and it will often be possible to achieve a favorable outcome before charges get filed.
Our federal health care fraud defense lawyers have successfully represented providers and other clients in DHHS matters involving all types of program billing fraud allegations. This includes allegations such as:
- Billing for medically-unnecessary services or supplies
- Billing for services not rendered or supplies not provided
- Double-billing the federal government and private insurers
- Upcoding, unbundling, and other forms of coding fraud
- Violations of the Anti-Kickback Statute and Stark Law
Similar to DHHS contract fraud, allegations of DHHS program fraud can lead to substantial penalties. These penalties can include recoupments, denial of pending claims, prepayment review, fines, program exclusion, and federal imprisonment.
3. DHHS Grant Fraud
The Department of Health and Human Services, “is the largest grant-making organization in the federal government, and its funding of health and human services programs touches the lives of almost all Americans.” As a result, DHHS OIG heavily scrutinizes grant applications and grant recipients’ conduct, and it routinely pursues investigations targeting various forms of grant fraud.
In DHHS grant fraud investigations, grant recipients can face the same types of penalties as DHHS contractors and Medicare and Medicaid participants. Grant recipients that are facing DHHS investigations must therefore take their circumstances very seriously, and they must rely on the advice and representation of experienced federal defense counsel. At Oberheiden P.C., we represent DHHS grant recipients in investigations targeting allegations including (but not limited to):
- Submitting false information in grant applications
- Submitting false information in support of grant extensions and renewals
- Falsifying research and study outcomes
- Making false statements to DHHS personnel pertaining to the use of grant funds
- Offering bribes and other prohibited forms of compensation
4. DHHS’s “Operation CARE”
DHHS’s “Operation CARE” is focused fraud impacting residents of long-term care facilities, including nursing homes. Among other priorities, Operation CARE focuses on targeting healthcare providers that provide medically unnecessary services to residents—including both unnecessary testing and unnecessary treatment. Operation CARE emphasizes fraudulent billings for prescriptions as well.
Anytime a particular segment of the healthcare industry is subject to enhanced scrutiny from DHHS, there is a significantly increased risk that providers in the segment will face audits and investigations targeting possible billing fraud. We represent physicians, laboratories, nursing homes, and other providers targeted under Operation CARE, and we have had significant success in this area of Department of Health and Human Services fraud defense as well.
Defending Against Allegations of Department of Health and Human Services Fraud
When facing a DHHS investigation, there are a variety of defense strategies available. The specific defenses that providers (and other entities and individuals) can assert depend on the particular facts and circumstances involved. Generally speaking, however, the types of defense strategies we use to protect our clients in Department of Health and Human services fraud matters are designed to resolve our clients’ cases before charges get filed. In many cases, we are able to help our clients avoid liability entirely, and we are able to help them get back to business as usual without unwarranted and unnecessary consequences.
FAQs: Department of Health and Human Services Fraud Defense
How Does the Department of Health and Human Services Choose Its Targets for Fraud Investigations?
The Department of Health and Human Services identifies contractors, healthcare providers, and other entities and individuals to target in fraud investigations through a variety of means. For example, DHHS relies heavily on whistleblowers to report suspected cases of fraud, waste, and abuse—and it compensates whistleblowers handsomely when their tips lead to successful prosecution. DHHS relies heavily on data analytics as well, and it will often initiate investigations based upon information received from other agencies.
What are the Chances of Resolving a Department of Health and Human Services Fraud Investigation Without Liability?
The chances of resolving a Department of Health and Human Services fraud investigation without liability depend on the circumstances involved. However, if your business or practice has not committed fraud, then there is no reason why you should expect to face liability. We have a proven track record of resolving our clients’ cases without liability—even in cases in which there are legitimate questions as to whether our clients have fully complied with their federal obligations.
What Should I Do if I Am Aware of Fraud?
If you have reason to believe that a Department of Health and Human Services fraud investigation could lead to liability, you need to seek advice from experienced defense counsel. While it might be in your interests to self-disclose, it also might not, and self-disclosing unnecessarily could lead to unnecessary consequences. Our attorneys can advise you, and we can take immediate action on behalf of your business or practice if necessary.
When Is It Time To Engage Defense Counsel for a Department of Health and Human Services Fraud Investigation?
If you are aware of a pending or ongoing Department of Health and Human Services fraud investigation, it is time to engage defense counsel. You will need your defense counsel to intervene in the investigation, and you will need to begin working with your counsel immediately to build and execute a strategic defense.
Speak with a Department of Health and Human Services Fraud Defense Lawyer at Oberheiden P.C.
If you need to engage Department of Health and Human Services fraud defense counsel, we encourage you to contact us immediately for a free and confidential case assessment. To speak with a senior attorney at Oberheiden P.C., call 888-680-1745 or tell us how we can reach you online now.