Dade County Healthcare Fraud Lawyers
If federal agents are investigating you or your healthcare practice in Florida, you need experienced Dade County healthcare criminal defense lawyers at Oberheiden, P.C., on your side. Anyone working in the healthcare industry in Dade County, Florida – whether as a provider or a corporate officer or owner in a healthcare 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 healthcare 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 healthcare 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 healthcare professionals. While our Dade County healthcare fraud attorneys, 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 Healthcare Fraud?
There are many kinds of healthcare 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 Healthcare Statutes and Other Sources of Law You Need to Know
1. The False Claims Act
It is absolutely critical that healthcare 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 healthcare 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 healthcare system, incentivizing others to bring civil claims against healthcare 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 healthcare 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 healthcare fraud attorney 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 Healthcare 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 “healthcare fraud statute.” It reads (in part): (a) “Whoever knowingly and willfully executes, or attempts to execute, a scheme or artifice – (1) to defraud any healthcare 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 healthcare benefit program, in connection with the delivery of or payment for healthcare 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 healthcare fraud lend themselves to other, closely related fraud charges. Accordingly, these and other charges may also appear on federal indictments of healthcare 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 healthcare 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.) Healthcare 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 healthcare 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 healthcare 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 Healthcare Fraud Defense Attorneys
Here are five reasons why healthcare professionals and business entities should choose Oberheiden, P.C., as their Dade County federal healthcare fraud defense lawyers:
- Our Extensive Experience in Healthcare Fraud Investigations – Because healthcare 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 healthcare criminal case (from investigation all the way through trial). When you hire Oberheiden, P.C., the only healthcare fraud defense attorney working on your case will be senior-level defense lawyers with extensive experience specific to healthcare 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., each Dade County healthcare fraud lawyer in our team has 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 Healthcare Fraud Defense – Because of our extensive focus in this area, we believe we are capable of providing a robust and strategic defense in any healthcare 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 healthcare 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 healthcare fraud attorneys believe this attitude is responsible for our substantial track record of achieving favorable results.
Frequently Asked Questions
What is the difference between the Anti-Kickback Statute and the Stark Law?
While both the Anti-Kickback Statute (AKS) and the Stark Law place significant limits on a provider’s ability to receive referral payments, the two laws are very distinct in several respects. The AKS is a criminal law that forbids providers from receiving or paying anything of value for referring a patient whose medical bills are covered under a federal program, such as Medicaid or Medicare. Meanwhile, the Stark Law applies to all patients, regardless of whether they receive government benefits. However, the Stark Law is aimed at limiting the situations in which a provider refers patients to another practice in which the referring party stands to receive financial gain. Although both statutes can result in significant civil liability, only the AKS carries the possibility of criminal sanctions. If you are at the center of a healthcare fraud investigation, reach out to an experienced Dade County, FL federal healthcare fraud defense attorney today.
What is the Eliminating Kickbacks in Recovery Act?
In an effort to reduce the number of people who profit from referring patients in need of treatment, Congress passed the Eliminating Kickbacks in Recovery Act (EKRA) in 2018. EKRA prohibits accepting or paying kickbacks for referrals to recovery homes, clinical treatment facilities, or laboratories. While EKRA focuses on payments made by recovery homes, clinical treatment facilities, and laboratories, the law’s reach extends beyond these organizations. This is because any healthcare provider or professional who refers patients to any of these facilities may be in violation of the law’s anti-kickback provision. If you operate a recovery home, clinical treatment facility, or laboratory or refer patients to these practices, it is imperative you discuss the referral arrangement with an experienced Dade County federal healthcare fraud defense attorney.
What are the most common examples of Medicare Fraud?
Medicare fraud involves any fraudulent or false claim submitted to the Medicare program for reimbursement. It also includes overcharging the government for the services that were actually provided to the patient. Some of the most common examples of Medicare fraud include the following:
- Billing for services that were not performed;
- Billing for services that were not medically necessary;
- Billing for supplies or equipment that were never ordered;
- Billing for supplies or equipment that were not medically necessary;
- Certification for services or supplies that were not medically necessary;
- Double billing, up-coding, and inflating bills; and
- Overutilization of services or equipment.
Healthcare fraud laws also prohibit certain referral relationships between practitioners. For example, under the Anti-Kickback Statute, providers cannot receive anything of value for referring a patient whose medical expenses are paid for by Medicare. If you find yourself at the center of a healthcare fraud investigation, reach out to a respected Florida federal healthcare fraud defense attorney as soon as possible.
Discuss Your Federal Healthcare Fraud Investigation in Confidence
If your Dade County healthcare practice or company is being targeted in a federal healthcare fraud investigation, we urge you to contact our proven Dade County healthcare fraud lawyers for a free and confidential case assessment. To speak with a member of our federal defense team, right away, call 888-680-1745 or inquire online as soon as possible.