Florida Health Care Fraud
Proven Florida Health Care Fraud Defense Lawyers
From Jacksonville to Miami, health care providers throughout Florida are being targeted in high-stakes federal health care fraud investigations. If you have received a target letter or subpoena, or if you been contacted by agents from an agency such as the DOJ, DEA, or OIG, it is important that you speak with our Florida federal health care fraud defense lawyers as soon as possible.
Health care providers in Florida face a major dilemma. For many providers, participating in government benefit programs such as Medicare, Medicaid, and Tricare is essential to maintaining their financial solvency. However, participating in these programs also exposes them to federal health care fraud investigations. And with the potential for both civil and criminal penalties, a Medicare, Medicaid, or Tricare fraud investigation could also mean the end of their practice. While this may sound bleak, it is today’s reality. Health care providers in Florida and nationwide are being targeted in federal fraud investigations, and those who fail to defend themselves are suddenly facing practice-threatening (and potentially life-changing) consequences.
Oberheiden, P.C., is a federal health care fraud defense law firm that represents providers across the state of Florida and nationwide. With a team of highly experienced Florida health care fraud defense lawyers and former federal prosecutors, we take a strategic and knowledge-based approach to defending clients in all health care fraud matters. This includes allegations under federal statutes such as the False Claims Act, Anti-Kickback Statute, and Stark Law, and investigations involving the Department of Justice (DOJ), Drug Enforcement Administration (DEA), Office of Inspector General (OIG), and other federal agencies.
Regardless of the specific circumstances at hand, if you are facing a federal health care fraud investigation, you need to take your situation extremely seriously. These investigations have the potential to lead to recoupments, fines, program exclusion, and even imprisonment. The special agents and prosecutors who handle these investigations are extremely good at what they do. To give yourself a fighting chance, you need to intervene in the investigation and execute a proactive defense strategy. This starts with hiring an experienced defense team as soon as possible. Contact our proven team of Florida health care fraud defense lawyers today.
What Is Health Care Fraud?
As a physician, pharmacist, or other health care provider, what does it mean to be accused of health care fraud? The answer to this question is not as straightforward as it may seem, and this presents one of the first challenges to defending against an investigation involving the DOJ, DEA, OIG, or another federal law enforcement agency. Depending upon the circumstances involved, a federal “health care fraud” investigation could be based upon allegations including:
- Providing and billing for medically-unnecessary services
- Billing for services not actually rendered to patients
- Falsifying patient records, prescriptions, physician certifications, and election statements
- Offering or accepting illegal “kickbacks” or referral fees
- Prescribing opioid medications to drug-dependent patients, diverting opioid prescriptions, and other forms of prescription drug fraud
If you do not know what you are being accused of, how can you defend yourself effectively? The simple answer is: you can’t. As a result, when facing a federal health care fraud investigation in Florida, you need to engage a legal team that can effectively intervene in the investigation and quickly gather the information necessary in order to build a strategic defense. This includes information such as:
- Which federal agencies and task forces are involved in the investigation?
- What triggered the investigation?
- Is the investigation civil or criminal in nature?
- How long has the investigation been ongoing?
- What are the specific allegations against you?
- What evidence has the federal government gathered to date?
- Are federal authorities targeting other health care providers or entities in the investigation as well?
Sources of Authority in Federal Health Care Fraud Investigations
1. The False Claims Act
The False Claims Act (FCA) imposes civil and criminal penalties for the submission of “false or fraudulent” claims for payment by the federal government – including payment under Medicare, Medicaid, Tricare, and other health care benefit programs. This includes intentional and unintentional billing and coding errors as well as various other forms of health care fraud. Civil penalties under the FCA include fines, recoupments, treble damages, and program exclusion. Criminal penalties include fines and federal imprisonment.
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) prohibits health care providers from offering, paying, soliciting, or accepting any rebate, referral fee, kickback, or other form of remuneration in exchange for a program-reimbursed patient referral. The AKS includes provisions for civil and criminal penalties. However, it also provides a list of “safe harbors” that insulate certain types of relationships and transactions from civil or criminal culpability.
3. The Stark Law
The Stark Law prohibits so-called “physician self-referrals.” While the Stark Law is similar to the Anti-Kickback Statute in that it targets unlawful referral fees, it also differs in many important respects. Most notably, the Stark Law is exclusively civil in nature. It is also limited in scope to transactions between physicians and their related entities, and it only applies to transactions involving “designated health services.” Nonetheless, federal authorities routinely use the Stark Law to target physicians in federal investigations, and civil penalties under the Stark Law can be substantial.
4. The Controlled Substances Act
The Controlled Substances Act (CSA) is under the jurisdiction of the DEA, and it is one of the primary federal statutes used to prosecute prescription drug diversion and other forms of pharmaceutical fraud. Practitioners who prescribe, administer, and dispense controlled-substance medications must maintain strict compliance with the conditions for DEA registration, and they are subject to routine compliance investigations. However, if there is evidence to suggest that a health care provider is engaging in fraudulent prescription practices, the DEA will not hesitate to launch a targeted investigation outside of the routine registrant monitoring process.
5. The Federal Health Care Fraud Statute
The health care fraud statute, 18 U.S.C. 1347, makes it a federal offense to “knowingly and willfully” defraud or attempt to defraud any health care benefit program or seek to secure payment from a health care benefit program by “false or fraudulent pretenses.” 18 U.S.C. 1347 is a criminal statute, and health care providers convicted of knowingly and willfully defrauding the federal government can face enormous fines and years, if not decades, behind bars.
6. Program Billing Regulations
The regulations that govern providers’ Medicare, Medicaid, and Tricare billing practices are extraordinarily complex. However, this does not provide an excuse for non-compliance. Violations of program billing regulations can lead to charges under the False Claims Act and other statutes. And due to the government’s heavy reliance on data analytics to identify potential instances of fraud, they are among the most common triggers for federal health care fraud investigations in Florida.
7. Other Federal Criminal Statutes
In addition to the federal statutes and regulations that focus specifically on federal health care benefit program compliance, providers targeted in criminal investigations can face charges under various other federal statutes as well. For example, in large-scale criminal investigations, it is not uncommon for providers to face allegations including:
- Bank fraud
- Mail and wire fraud
- Money laundering
- Tax evasion
5 Reasons Why Health Care Providers Trust Oberheiden, P.C.’s Florida Federal Health Care Fraud Defense Lawyers
Whether you are being targeted for civil or criminal prosecution, and whether your investigation involves allegations of billing and coding errors or unlawful referral fees, you need to engage a defense law firm that can help you take on the federal government effectively. At Oberheiden, P.C., we have helped numerous clients in Florida and nationwide avoid criminal charges. We have effectively represented clients at all stages from investigation through indictment, plea deal negotiations, trials, and appeals. When you choose our Florida health care fraud defense lawyers to represent you in Florida:
- We will use our vast experience to execute a strategic defense. Our Florida health care fraud defense lawyers have centuries of combined legal experience on both sides of federal health care fraud investigations.
- We will customize our strategy to your unique individual and business circumstances. We know that the most effective defense strategies are those that are custom-tailored to the facts at hand.
- We will work tirelessly to resolve your case as quickly and discreetly as possible. If at all possible and in your best interests, our Florida health care fraud defense lawyers will seek resolve your case without charges being filed.
- We will aggressively defend your legal rights. From asserting safe harbors to exposing constitutional violations, we will aggressively defend your legal rights.
- We will keep you involved and make sure you feel confident in your defense. As our client, it is our goal to make sure you feel confident and satisfied at every stage of our representation.
Discuss Your Legal Matter with Our Federal Health Care Fraud Defense Attorneys
If your health care business or practice is being targeted by agents from the DOJ, DEA, OIG, or another federal agency, we encourage you to contact our Florida health care fraud defense lawyers immediately to schedule a free initial case assessment. To speak with an attorney on our federal health care fraud defense team in confidence, please call 888-519-4897 or tell us how we can help online now.