Dade County Health Care Fraud
If federal agents are investigating you or your health care practice in Florida, you need experienced Dade County health care criminal defense lawyers at Oberheiden, P.C., on your side.
Anyone working in the health care industry in Dade County, whether as a provider or a corporate officer or owner in a health care business, should know that federal agents are currently targeting the greater Miami area – and have been for several years now.
Why Dade County? The area has one of the largest populations of Medicare and Medicaid recipients in the country. (For that matter, it is one of the largest and fastest-growing metropolises in the southern United States, period.)
Accordingly, federal agents from the Department of Justice (DOJ) and the Department of Health and Human Services’ Office of Inspector General (DHHS – OIG) have invested substantial resources in the area, aimed at taking down doctors and other health care professionals who are suspected of committing fraud against the U.S. government.
These agencies also work closely with officers from the DEA, FBI, IRS, and even state law enforcement agencies. They investigate Dade County health care providers on everything from opioid diversion and pharmaceutical fraud to tax fraud, mail fraud, wire fraud, identity theft, and beyond.
Oberheiden, P.C. is a federal criminal defense law firm with a national presence. Combined, our attorneys have spent over 100 years in criminal defense. Additionally, several of our lawyers are former federal prosecutors, having worked in the Department of Justice or other offices.
In the majority of our cases, we have been able to avoid the filing of criminal charges against health care professionals. While our Dade County health care fraud lawyers, of course, cannot promise a particular outcome, we want you to know that we will always fight for the optimal outcome. That means keeping our clients licensed, in practice, in business, out of prison, and free from crippling criminal or civil fines whenever possible. More often than not, we’ve met those goals for the people and businesses we serve.
What Is Health Care Fraud?
There are many kinds of health care fraud. Some common examples include:
- Billing fraud (phantom billing, upcoding, false claims, etc.)
- Department of Labor (DOL) fraud
- Anti-Kickback Statute violations
- Stark Law violations (physician self-referral)
- Prescription drug fraud and other Controlled Substances Act (CSA) / DEA registration violations
- Billing for services that are not medically necessary
- Billing for services you never actually provided
- Falsifying patient records, prescriptions, physician certifications, or election statements
Federal Health Care Statutes and Other Sources of Law You Need to Know
1. The False Claims Act
It is absolutely critical that health care providers understand the federal False Claims Act (FCA) and fully appreciate its expansive scope. The FCA makes it a criminal offense to send “false or fraudulent” payment claims to a federal health care program (e.g., Medicare, Medicaid, Tricare, DOL, etc.). The penalty for a false claim can range from a prison sentence to mountainous and impossible civil or criminal fines (which can apply in the tens to thousands of dollars per false claim submitted). Those convicted also face potential program exclusion. The FCA also provides the most robust whistleblower and qui tam provisions in the federal health care system, incentivizing others to bring civil claims against health care providers – claims that can quickly trigger criminal investigations. Learn more about the False Claims Act.
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) provides substantial restrictions on health care providers’ ability to engage in certain marketing techniques that would be considered “fair game” in many other industries. Under the AKS, it is illegal to offer, pay, solicit, or receive remuneration in exchange for patient referrals. Notably, prosecutors must be able to prove that the violation was intentional in order to convict. “Remuneration,” meanwhile, is broadly defined. An AKS investigation can be civil or criminal in nature. Our office and Dade County health care fraud lawyers can help in either event.
3. The Stark Law
The Stark Law pertains specifically to “physician self-referrals,” which are unlawful under the Stark Law and may lead to extensive civil penalties. We urge any Dade County physicians, who treat Medicare or Medicaid beneficiaries and who are concerned about a potential physician self-referral investigation, to contact our office as soon as possible.
4. The Federal Health Care Fraud Statute
It is not uncommon for federal prosecutors to seek charges under as many different federal statutes as possible (often with multiple counts of each). One especially common statute is 18 U.S.C. 1347, also known as the “health care fraud statute.” It reads (in part):
(a) “Whoever knowingly and willfully executes, or attempts to execute, a scheme or artifice –
(1) to defraud any health care 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 health care benefit program, in connection with the delivery of or payment for health care benefits, items, or services, shall be fined under this title or imprisoned not more than 10 years, or both…”
5. Other Fraud Statutes
Allegations of health care fraud lend themselves to other, closely related fraud charges. Accordingly, these and other charges may also appear on federal indictments of health care providers in Dade County:
- Mail fraud
- Wire fraud
- Bank fraud
- Money laundering
- Tax fraud
- Making false statements
- Wrongful use of identifying health information
For these reasons, it is in your best interest to hire a law firm with experience in a wide range of federal fraud allegations in addition to health care fraud, specifically.
6. Program Billing Regulations
Federal benefits programs often impose their own internal billing regulations. Violating these regulations, even unintentionally, may result in prosecution. (Whereas most fraud charges require proof of intent, prosecution for violating program billing regulations typically does not require proof of intent.) Health care providers in Dade County are urged to maintain a proactive compliance program to mitigate the risk of unwittingly violating a federal billing regulation.
7. DOJ Mandates
The Department of Justice routinely issues public announcements identifying new law enforcement priorities and “task forces.” These mandates are important because, though they are not “law” per se, they do play a role in determining when, where, how, and on what grounds federal agents will arrest health care professionals. Recently, the DOJ has intensified its focus on opioid fraud and abuse, launching both the Opioid Fraud and Abuse Detection Unit and the Prescription Interdiction & Litigation (PIL) Task Force within a matter of months.
8. The Controlled Substances Act (CSA)
The Controlled Substances Act is one of the primary federal statutes used to prosecute providers suspected of pharmaceutical fraud schemes. Examples of pharmaceutical fraud include writing unnecessary prescriptions and offering prescriptions or medications in exchange for cash, sex, or other incentives. The CSA is also used to prosecute health care providers (including doctors, nurses, pharmacists, business owners, and others) on drug-related charges, especially in connection with suspected opioid diversion.
5 Reasons to Trust Oberheiden, P.C., as Dade County Federal Health Care Fraud Defense Attorneys
Here are five reasons why health care professionals and business entities in the Dade County area should choose Oberheiden, P.C., as their federal health care fraud defense attorneys:
- Our Extensive Experience in Health Care Fraud Investigations – Because health care fraud cases are typically complex and because the stakes are incredibly high, you should choose a defense firm with years of hands-on experience at every stage of a health care criminal case (from investigation all the way through trial). When you hire Oberheiden, P.C., the only attorneys working on your case will be senior-level defense lawyers with extensive experience specific to health care fraud defense.
- Our Record of Avoiding Charges – While every case is unique and we cannot guarantee specific results, we are proud of our track record. At Oberheiden, P.C., our Dade County health care fraud lawyers have avoided criminal charges for the majority of our clients. Avoiding charges is the most effective way to resolve a criminal investigation, and we do everything we can to achieve that goal in every case.
- Our Experience on Both Sides – Several of the lawyers at Oberheiden, P.C., are former federal prosecutors. So much of our defense work involves communicating and negotiating with the federal government. Because several of our attorneys used to work on the other side, they bring an invaluable perspective to our negotiations and defense strategies.
- Our Focus on Federal Health Care Fraud Defense – Because of our extensive focus in this area, we believe we are capable of providing a robust and strategic defense in any health care criminal matter. We are available to represent doctors, pharmacists, physician’s groups, ambulance providers, medical clinics, hospitals, hospices, medical laboratories, mobile labs, diagnostic companies, and virtually any other health care providers in Dade County.
- Our Aggressive Defense Strategies – When the stakes are high, you need attorneys who will fight for you with passion. We adopt an aggressive, foot-on-the-pedal approach for every client we represent. Our Dade County health care fraud attorneys believe this attitude is responsible for our substantial track record of achieving favorable results.
Discuss Your Federal Health Care Fraud Investigation in Confidence
If your Dade County health care practice or company is being targeted in a federal health care fraud investigation, we urge you to contact our proven Dade County health care fraud lawyers for a free and confidential case assessment. To speak with a member of our federal defense team, right away, call (214) 692-2171 or inquire online as soon as possible.