East Virginia Health Care Fraud
Established East Virginia Health Care Fraud Lawyers
Federal agents and prosecutors are targeting health care providers in eastern Virginia for prosecution under the False Claims Act, Anti-Kickback Statute, and other federal laws. These investigations have the potential to lead to substantial financial penalties, program exclusion, and even federal imprisonment. If you are under investigation it is vital you discuss the matter with respected and proven East Virginia health care fraud lawyers at Oberheiden, P.C.
For health care providers in Alexandria, Richmond, Roanoke, and other cities in eastern Virginia, the risk of being targeted in a federal investigation is very real. Federal agencies, including the U.S. Department of Justice (DOJ), Drug Enforcement Administration (DEA), and Office of Inspector General (OIG), are aggressively targeting local providers for federal prosecution, with allegations ranging from over-billing Medicare and Medicaid to selling prescription opioids to drug-dependent individuals.
If you have been accused of health care fraud, it is important that you speak with our East Virginia health care fraud lawyers as soon as possible. It may be possible to resolve your investigation without charges being filed, but only if you take proactive steps to assert a strategic defense.
At Oberheiden, P.C., we focus our practice specifically on defending health care providers in federal matters. We handle civil and criminal investigations throughout eastern Virginia, from the Washington D.C., suburbs to Norfolk and Newport News. Our East Virginia health care fraud lawyers represent all types of health care providers, including individual practitioners and corporate organizations, and we provide strategic defense representation that is designed to secure a favorable outcome as quickly, cost-effectively, and discretely as possible.
Could I Be Guilty of Health Care Fraud?
Although “health care fraud” is currently a top federal law enforcement priority, this term is not exactly well defined. Instead, health care fraud is considered an umbrella term for various statutory and regulatory violations that have to do with overbilling government programs and private insurance carriers and engaging in other “fraudulent” practices that have direct or indirect negative consequences for patients or payors. In order to determine whether you are at risk for civil or criminal penalties as the result of a federal health care fraud investigation, it is first necessary to identify the specific allegations that triggered the government’s inquiry into your business or practice.
Surprisingly, this is not often as easy as it sounds. In federal health care fraud investigations, agents and prosecutors typically play their cards close to the vest. Their goal is to secure recoupments or a conviction. And if it is in their best interests to legally keep information from you, they will. But, this does not mean that you are helpless to defend yourself. At Oberheiden, P.C., our East Virginia health care fraud lawyers have the experience necessary to discern the bases for our clients’ investigations, which often include:
- Medicare, Medicaid, and Tricare coding violations (“billing fraud”)
- Department of Labor (DOL) fraud
- Anti-Kickback Statute violations
- Stark Law violations
- Controlled Substances Act and DEA registration violations (including prescription drug diversion)
- Providing and billing for medically-unnecessary services
- Billing for services not actually rendered to patients (also known as “phantom billing”)
- Falsifying patient records, prescriptions, physician certifications, and election statements
In addition to determining the specific allegations against you, it is also necessary to determine whether the government’s investigation is civil or criminal in nature. If your investigation is civil, you could face fines, recoupments, civil assessments, program exclusion, and other economic penalties, but prison time will not be on the table. Since many federal statutes include provisions for both civil and criminal punishment, determining the nature of your investigation can be challenging as well; once again, this is where our East Virginia health care fraud lawyers’ centuries of combined legal experience comes into play.
What Federal Statutes and Regulations Are Used to Prosecute Health Care Fraud?
1. The False Claims Act
The False Claims Act (FCA) prohibits health care providers from submitting “false and fraudulent” claims for federal program reimbursement. This includes overbilling Medicare, Medicaid, Tricare, and the Department of Labor. The FCA is one of the statutes we mentioned above that includes civil and criminal penal provisions. In both types of cases, the relevant penalties apply on a per claim basis.
The key difference between civil and criminal liability under the False Claims Act is intent. Intentional efforts to defraud the government will trigger criminal prosecution, while health care providers who knew or should have known of unlawful billing practices will often be at risk for hundreds of thousands or millions of dollars in civil monetary penalties.
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) prohibits health care providers from offering, paying, soliciting, or accepting any form of “remuneration” in exchange for a referral for program-reimbursed medical services, equipment, or supplies. This includes cash referral fees and other incentives as well as travel, meals, and all other forms of in-kind compensation. Similar to the False Claims Act, the AKS includes provisions for both civil and criminal penalties.
In Anti-Kickback Statute investigations, a key defense strategy will often be to assert one or more of the AKS’s statutory “safe harbors.” These safe harbors provide an absolute defense to liability in both civil and criminal cases.
3. The Stark Law
The Stark Law prohibits unlawful compensation arrangements between physicians and their “related entities” in transactions involving “designated health services.” Unpacking this definition is a task unto itself, let alone convincing federal prosecutors that their attempts to prosecute an alleged “physician self-referral” are misguided.
The Stark Law is unique from the False Claims Act and the Anti-Kickback Statute in that it is exclusively a civil statute. It is also unique in that it only applies to physicians. However, physicians targeted under the Stark Law can still face practice-threatening consequences, and avoiding these consequences requires skilled and strategic defense representation.
4. The Controlled Substances Act
The Controlled Substances Act is one of the primary federal statutes used to prosecute health care providers suspected of diverting prescription medications and other forms of prescription drug fraud. All health care providers that prescribe and dispense regulated medications are required to register with the DEA, and the DEA aggressively monitors and targets health care providers suspected of engaging in Controlled Substances Act violations.
5. The Federal Health Care Fraud Statute
Under the health care fraud statute, 18 U.S.C. 1347, it is unlawful to, “knowingly and willfully execute, or attempt to execute, a scheme or artifice . . . to defraud any health care benefit program . . . [or] 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.” While this may initially sound similar in scope to the False Claims Act, it actually provides federal authorities with an even more potent weapon to prosecute health care providers in many cases.
6. Health Care Benefit Program Billing Regulations
In addition to these statutory authorities, health care providers that bill Medicare, Medicaid, Tricare, and the Department of Labor are subject to a bevy of federal regulations as well. These regulations are extraordinarily voluminous and almost unbelievably broad in their scope. Even the most minute regulatory missteps can potentially expose health care providers to recoupments, fines, and other penalties.
7. Criminal Statutes of General Applicability
Beyond the laws and regulations that apply specifically to health care providers, in federal health care fraud investigations, DOJ prosecutors will often pursue charges under a range of statutes of general applicability as well. These include:
- 18 U.S.C. 371 (criminal conspiracy)
- 18 U.S.C. 1028A (identity theft)
- 18 U.S.C. 1341 (mail fraud)
- 18 U.S.C. 1343 (wire fraud)
- 18 U.S.C. 1344 (bank fraud)
- 18 U.S.C. 1357 (money laundering)
- 26 U.S.C. 7206 (tax fraud)
Why Do Health Care Providers in East Virginia Choose Oberheiden, P.C.?
When you are at risk for losing your health care practice or medical business as the result of a federal investigation, your choice of legal representation is critical. So, why have so many providers chosen Oberheiden, P.C.’s East Virginia health care fraud lawyers when their future was on the line?
- Centuries of Combined Experience on Both Sides of Health Care Fraud Investigations – Our federal health care fraud defense team includes several former DOJ prosecutors, and our senior attorneys have centuries of combined experience in federal matters.
- A Track Record that Includes Resolving Most Cases without Charges Being Filed – While we take our clients’ cases to trial when necessary, our East Virginia health care fraud lawyers have resolved the vast majority of our clients’ investigations without charges ever being filed.
- An Exclusive Focus on Federal Health Care Fraud Defense – We focus our practice on federal health care fraud matters. We know what is at stake for health care providers targeted by the DOJ, DEA, and OIG, and we know what it takes to assert a successful defense.
- Trial–Tested Defense Strategies and an Aggressive Posture in Litigation – We rely on trial-tested strategies at all stages of our clients’ cases, and our East Virginia health care fraud attorneys use an aggressive posture to secure leverage in negotiations with federal prosecutors.
- Detail–Oriented and Client-Centric Legal Representation – When it comes to distinguishing between lawful billing practices and criminal Medicare fraud, the details can make all the difference. Our East Virginia health care fraud lawyers work closely with our clients to identify the facts that support optimal outcomes in their federal health care fraud investigations.
Contact Our East Virginia Federal Health Care Fraud Defense Attorneys
If you are facing a federal health care fraud investigation in east Virginia, contact us now to schedule a free initial consultation with a member of our experienced defense team. Call (888) 519-4897 to schedule an appointment, or tell us how to reach you and our East Virginia health care fraud attorneys will be in touch as soon as possible.
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