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Oberheiden Attorneys

Defending Anti-Kickback Charges in DOL Pharmacy Investigations

Categories: Anti-Kickback Issues

pharmacy investigations

 

Dr. Nick Oberheiden, Esq.
www.federal-lawyer.com
Direct: (214) 469-9009
1-800-810-0259
Including Weekends

The attorneys of Oberheiden & McMurrey, LLP have seen a tremendous increase in government investigations into pharmacies and compound pharmacies that service beneficiaries of the Department of Labor’s (DOL) healthcare program. The following is a brief summary of the government’s DOL anti-kickback and healthcare fraud campaign, Oberheiden & McMurrey, LLP insights presented by its former federal prosecutors, and our experience as defense counsel in several DOL matters.

2016-2017: DOL-Kickback Prosecutions

Since 2016, the Department of Justice has significantly expanded its efforts and increased its resources to investigate the referral practice between DOL providers and pharmacies, especially compound pharmacies. Agents of the United States Postal Inspection Service (USPIS), the Office of Inspector General (OIG), and the Federal Bureau of Investigation (FBI) were instructed by local U.S. Attorney’s Offices and the Department of Justice to secure evidence demonstrating the illegal exchange of marketing and referral monies. Today, federal prosecutors have begun to prosecute some of the country’s largest DOL providers, pharmacies, and marketing groups and almost no week goes by without press releases of new raids, arrests, and prosecutions in the context of Department of Labor referrals. Focus of the investigations is the triangle between referring physician, marketer, and pharmacy.

  • Investigation of Physicians for Referring DOL Patients in Exchange for Money.
  • Investigation of Marketers for Receiving a Percentage Commission for Bringing Federal Workers’ Compensation Business to the Pharmacy. Federal Law Strictly Prohibits Percentage-Based Commission on Medicare, Medicaid, Tricare, and DOL Business.
  • Investigation of Pharmacy Owners for Paying Marketers Commissions on DOL Business and/or for Illegally Incentivizing Physicians to Refer DOL Patients to the Pharmacy.

The attorneys of Oberheiden & McMurrey, LLP have been on the forefront of these prosecutions and were called to defend physicians, lawyers, marketing groups, healthcare executives, and pharmacies across the United States against civil and criminal prosecutions. Please see below for our healthcare fraud defense track record.

Unlike most other industries, the healthcare industry strictly prohibits to pay for business on a quid-pro-quo basis. Legislative intent behind the money-for-business (“kickback”) prohibition in healthcare is to protect patients from the undue influence of monetary considerations when it comes to making the right treatment decisions. Federal law, 42 U.S.C. Sect. 1320a-7b, forbids offering, paying, soliciting, or receiving kickbacks, bribes, or rebates, regardless as to whether in cash or otherwise, directly or indirectly for referring patients to providers in return for:

  • An item or service covered by Medicare, Medicaid, or other federal healthcare programs such as Tricare or patients covered by the Department of Labor;
  • Buying, leasing, or ordering any item, service, or facility covered by Medicare and other federal healthcare programs such as Medicaid, Department of Labor patients, and Tricare.

Importantly, the federal Anti-Kickback Statute does not require specific intent. Simply doing something contrary to the statute is sufficient to be held accountable.

What Are Potential Penalties?

Kickback and healthcare fraud allegations in the context of federal workers’ compensation compound scripts are being investigated by various branches of the government, which include the Office of Inspector General (OIG), the Department of Health and Human Services (HHS), the U.S. Postal Inspection Service (USPIS), the Federal Bureau of Investigation (FBI), the Department of Justice (DOJ), and, to lesser extent, the Drug Enforcement Administration (DEA).

Violations of 42 U.S.C. Sect. 1320a-7b can be investigated as a civil or as a criminal case. Civil penalties, as amended by the Balanced Budget Act of 1997, include civil money penalties of up to $ 50,000 per violation, triple damages, and program exclusion. In more extreme cases, the government may prosecute the matter criminally. On the criminal side, violations of the federal Anti-Kickback Statute are felonies that are punishable by up to 5 years in prison, up to $ 25,000 in fines per occurrence, and an administrative provider exclusion from federal government programs.

Defending Anti-Kickback Charges

The attorneys of Oberheiden & McMurrey, LLP have defended clients—physicians, marketers, business owners, pharmacies, and even lawyers—against every form of federal healthcare fraud charges in connection with federal workers’ compensation business, Anti-Kickback violations, as well as alleged violations of the federal False Claims Act. Our team of former prosecutors and experienced defense attorneys have concluded a large number of healthcare fraud cases with no civil or criminal liability on behalf of our clients. Specifically, we have defended the following individual and corporate clients in Anti-Kickback cases:

  • Pharmacies
  • Toxicology Laboratories
  • Physicians
  • Healthcare Executives
  • Marketers
  • Consultants
  • Business Owners

Our number one goal in each healthcare investigation is to avoid criminal charges. As pointed out, the federal Anti-Kickback Statute has civil and criminal components and it is critical to plan an effective defense early to avoid criminal exposure. If you are under investigation for healthcare fraud or accused of a crime, you should speak with one of the experienced Oberheiden & McMurrey, LLP attorneys immediately. All consultations are free and confidential.

Who Can Help?

The attorneys of Oberheiden & McMurrey, LLP are healthcare fraud defense attorneys that help clients from across the country with effective defense strategies against government investigations. Instead of being walled off by secretaries, paralegals, and junior lawyers, all our clients have direct and instant access to senior lawyers.

  • Dr. Nick Oberheiden has successfully defended healthcare executives, physicians, and pharmacies against kickback, prescription fraud, false claims, and fraud allegations before the Office of Inspector General (OIG), Department of Justice (DOJ), Department of Defense (DOD), IRS, FBI, DEA, and other agencies. He is trained in negotiations by Harvard Law School and he received his Juris Doctor from UCLA School of Law as well as a PhD in law from the University of Heidelberg.
  • Attorney Lynette S. Byrd focuses her practice on civil and criminal litigation, Medicare and insurance audits, and general advice and counseling in health care law. She is a former Assistant United States Attorney with years of substantial trial experience under her belt who merges excellent litigation skills with profound understanding of the law.

Success Stories

  • Healthcare Fraud Investigation by the Department of Justice and the U.S. Attorney’s Office
    Result: No civil or criminal liability, case dismissed.
  • Healthcare Fraud Investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services
    Result: No civil or criminal liability, case dismissed.
  • Healthcare Fraud Investigation by the Department of Health and Human Services and the Office of Inspector General
    Result: No civil or criminal liability, case dismissed.
  • Healthcare Fraud Investigation by the Department of Defense
    Result: No civil or criminal liability, case dismissed.
  • Healthcare Fraud Investigation by the Office of Inspector General (OIG)
    Result: No civil or criminal liability, case dismissed.
  • Healthcare Fraud Investigation by the Department of Health and Human Services
    Result: No civil or criminal liability, case dismissed.
  • Healthcare Fraud Investigation by the Office of Inspector General (OIG)
    Result: No civil or criminal liability, case dismissed.
  • Healthcare Fraud Investigation by the Department of Justice
    Result: No civil or criminal liability, case dismissed.
  • Healthcare Fraud Investigation by the Office of Inspector General (OIG)
    Result: No civil or criminal liability, case dismissed.
  • Healthcare Fraud Investigation by the Office of Inspector General (OIG)
    Result: No civil or criminal liability, case dismissed.
  • Healthcare Fraud Investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services
    Result: No civil or criminal liability, case dismissed.

Free Consultation

If you feel like you are being audited or investigated or if you simply want to ask questions in a free and confidential setting, you should contact the experienced attorneys at Oberheiden & McMurrey, LLP. Get a free and confidential consultation and benefit from talking to former federal and state prosecutors and experienced healthcare defense attorney.

Oberheiden & McMurrey, LLP
National Criminal Defense
(800) 810-0259
www.federal-lawyer.com
This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Reading of this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. Oberheiden & McMurrey, LLP is a Texas LLP with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.
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