Ft. Lauderdale Healthcare Fraud Defense Lawyers
Healthcare providers in Ft. Lauderdale and throughout South Florida are being targeted in federal healthcare fraud investigations. At Oberheiden, P.C., our Ft. Lauderdale healthcare fraud defense lawyers represent healthcare providers nationwide in high-stakes federal matters. To discuss your case with a member of our federal healthcare fraud defense team in confidence, call 888-680-1745 now.
For healthcare providers in the Ft. Lauderdale area, the risk of being targeted in a federal investigation is very real. Agencies, including the Department of Justice (DOJ), Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), and Office of Inspector General (OIG), are aggressively pursuing providers suspected of improperly billing Medicare, Medicaid, and Tricare. And in many cases, these investigations are leading to civil or criminal charges. If your healthcare business or practice is being targeted in a federal investigation, you need to take steps to protect yourself immediately. The government may have been looking into your billing practices or business relationships for weeks – if not months – and if you fail to defend yourself, you could end up facing charges unnecessarily. While some federal healthcare fraud investigations target legitimate violations, the reality is that many of these investigations ultimately prove to be misguided. But, in order to convince the federal agents and attorneys handling your investigation that they don’t have a case to prosecute, you need to intervene in the investigation and assert a proactive defense. This means hiring experienced and strategic legal representation. At Oberheiden, P.C., our attorneys have centuries of combined experience on both sides of high-stakes federal matters. Along with our career defense attorneys, several members of our healthcare fraud defense team are former prosecutors who spent years – and in some cases, decades – with the DOJ. As a result, our highly experienced Ft. Lauderdale healthcare fraud defense lawyers know what to expect at all stages of the investigative and prosecutorial processes, and we know what strategies have proven effective in insulating healthcare providers from the risk of conviction at trial.
What Is Healthcare Fraud?
If your business or practice is under investigation for healthcare fraud, what exactly does this mean that federal authorities think you did wrong? Unfortunately, there is not one single answer, and this presents one of the first challenges of defending against a federal healthcare fraud investigation. While many investigations target healthcare providers’ billing practices (e.g., overbilling or double-billing Medicare, Medicaid, or Tricare), an investigation could just as easily involve allegations of accepting illegal “kickbacks” or making unlawful “self-referrals.” In order to identify the specific allegations against which we need to defend you, when you engage our federal healthcare fraud defense team in Ft. Lauderdale, our proven Ft. Lauderdale healthcare fraud defense lawyers will promptly and strategically intervene in the government’s investigation in order to determine:
- Why your business or practice is being targeted;
- Whether any other businesses or practices are being targeted in related investigations;
- Which federal agencies and/or task forces are handling the investigation;
- Whether the investigation is civil or criminal in nature; and
- What information federal authorities have gathered to support the allegations against you.
Once our committed Ft. Lauderdale healthcare fraud defense lawyers have secured this information, we can then use our experience in thousands of federal fraud investigations to develop and execute a defense strategy that is specifically tailored to the unique circumstances of your case. In most cases, this will involve defending against allegations of:
- Medicare, Medicaid, or Tricare coding violations (commonly referred to as “billing fraud”)
- Department of Labor (DOL) fraud
- Improper payments under the Anti-Kickback Statute or Stark Law
- Prescription drug fraud (including opioid medication diversion)
- DEA registration violations
- Providing and billing for medically-unnecessary services or medications
- Billing for services not actually rendered to patients
- Falsifying patient records, prescriptions, physician certifications, and election statements
Sources of Authority in Federal Healthcare Fraud Investigations
1. The False Claims Act
The False Claims Act (FCA) makes it a federal offense to submit any “false or fraudulent” claim for payment by a federal healthcare benefit program. This includes both intentional and unintentional billing violations, with intentional violations carrying the potential for criminal prosecution under the FCA. However, even in civil FCA investigations targeting unintentional violations, providers can still face substantial financial penalties and program exclusion. And federal prosecution may trigger state licensing board action as well.
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) prohibits the offering, solicitation, payment, or acceptance of any form of “remuneration” in exchange for a referral of a federal healthcare benefit program beneficiary. Similar to the False Claims Act, intentional violations of the AKS can trigger criminal prosecution while unintentional violations can expose providers to civil penalties.
3. The Stark Law
The Stark Law prohibits so-called “physician self-referrals.” This is somewhat similar to the prohibition on “remuneration” under the Anti-Kickback Statute, though the Stark Law differs from the AKS in several important respects. Most notably, the Stark Law is exclusively a civil statute, and it applies only to physicians and their related entities.
4. The Controlled Substances Act (CSA)
The Controlled Substances Act is one of the primary federal statutes used to prosecute providers suspected of prescription drug-related offenses, including various forms of pharmaceutical fraud. A CSA investigation can result in criminal prosecution, and providers who go to trial for alleged CSA violations can face years or decades in prison and exorbitant fines.
5. The Federal Healthcare Fraud Statute
The healthcare fraud statute, 18 U.S.C. 1347, makes it a federal offense to “knowingly and willfully . . . (1) . . . defraud [or attempt to defraud] any healthcare benefit program; or (2) . . . obtain [or attempt 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.” Violations of 18 U.S.C. 1347 can result in criminal prosecution, and they will often give rise to allegations under the False Claims Act and other statutes as well.
6. Program Billing Regulations
In addition to the federal statutes listed above, healthcare providers are subject to a host of regulations under the Medicare, Medicaid, Tricare, and DOL benefit programs. Regulatory violations can lead to statutory charges, and failure to maintain an effective compliance program is among the most common factors leading to dangerous federal investigations.
7. DOJ Mandates
The DOJ routinely issues releases identifying new law enforcement priorities and task forces. With increasing frequency, these initiatives are targeting individuals and entities in the healthcare industry. Recent initiatives include the formation of the Opioid Fraud and Abuse Detection Unit and Prescription Interdiction & Litigation Task Force, which combine the DOJ’s vast resources with those of other federal law enforcement agencies. These sources of authority are in addition to the numerous federal laws that are not specific to healthcare-related fraudulent offenses. When federal prosecutors pursue criminal charges for healthcare fraud, providers will frequently face charges for offenses such as conspiracy, bank fraud, mail fraud, wire fraud, and money laundering as well. These charges can carry the potential for decades behind bars.
5 Reasons to Choose the Winning Ft. Lauderdale Healthcare Fraud Defense Lawyers at Oberheiden, P.C., for Fraud Investigation
As a healthcare provider in Ft. Lauderdale, if you are at risk for fines, program exclusion, loss of licensure, and possibly even federal imprisonment, your choice of legal representation matters. Here are five reasons why healthcare providers across Florida and nationwide trust the federal healthcare fraud defense team at Oberheiden, P.C.:
- 90%+ Success Rate Avoiding Criminal Charges – We have resolved the majority of our clients’ cases without charges being filed, and more than 90% of our clients’ cases have been resolved without criminal prosecution.
- Broad Experience in Federal Healthcare Fraud Matters – Our Ft. Lauderdale healthcare fraud defense attorneys have centuries of combined experience on both sides of investigations involving the DOJ, DEA, FBI, OIG, and other federal agencies.
- Exclusive Focus on Healthcare Fraud Defense – Our firm’s exclusive focus is on federal healthcare fraud defense. We have handled thousands of cases, and we have developed a nationwide reputation as effective advocates for our clients.
- Aggressive Intervention and Pretrial Strategies – As our client, our dedicated Ft. Lauderdale healthcare fraud defense lawyers want to do everything possible to resolve your case as quickly and quietly as possible. This starts with intervening in the government’s investigation and executing a pretrial strategy focused on keeping your case out of federal district court.
- Trial-Ready Litigators with a Proven Track Record – While our goal is always to secure a favorable pretrial resolution, if our proven Ft. Lauderdale healthcare fraud defense lawyers need to go to court to protect you, we will be fully prepared to execute a cohesive, comprehensive, and strategic defense.
Frequently Asked Questions
What are the common types of healthcare fraud?
Healthcare fraud is a very broad term that can refer to a wide range of conduct. Below are some of the most common examples of healthcare fraud:
- 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
- Participating in an illegal kickback arrangement
- Certification for services or supplies that were not medically necessary
- Double billing, up-coding, and inflating bills
- Overutilization of services or equipment
In most instances, the federal government is not required to prove that you intended to defraud the government to establish civil liability. Thus, even well-intentioned providers can find themselves in the middle of a healthcare fraud investigation. If you believe that you are under investigation by the FBI, OIG, DEA, or any other federal agency, contact an experienced Florida federal healthcare fraud defense attorney immediately.
What is the False Claims Act?
The False Claims Act is a federal statute that bans anyone from submitting a false or fraudulent claim for reimbursement to a federal program. Although some investigations under the False Claims Act are the result of government investigations, many stem from a whistleblower’s allegations. Depending on the nature of the violation, punishments for a violation of the False Claims Act can carry both civil and criminal penalties. It is critical that you reach out to a Ft. Lauderdale, FL federal healthcare fraud defense attorney as soon as possible if you’re facing allegations that your practice ran afoul of the False Claims Act.
What should I look for in a Ft. Lauderdale, Florida federal healthcare fraud defense attorney?
Since they are exceptionally complex, healthcare fraud cases require a knowledge of both the applicable legal principles as well as the healthcare industry. When searching for a Ft. Lauderdale federal healthcare fraud defense attorney to defend against the government’s allegations, it is important to identify a lawyer who has specific experience successfully handling these particular claims. Law firms that have senior attorneys who used to work as federal healthcare fraud prosecutors will have the best insight into how the government will build and present its case, which can be tremendously advantageous.
Schedule a Free Case Assessment with Our Ft. Lauderdale Healthcare Fraud Defense Attorneys at Oberheiden, P.C.
Is your Ft. Lauderdale healthcare business or practice under investigation by the DOJ, DEA, FBI, OIG, or another federal agency or task force? If so, we encourage you to contact our Ft. Lauderdale healthcare fraud defense attorneys immediately for a free and confidential case assessment. To speak with a member of our federal healthcare fraud defense team, right away, call 888-680-1745 or tell us how to reach you online now.