Florida Healthcare Fraud Defense Lawyers - Oberheiden, P.C.
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Florida Healthcare Fraud Defense Attorneys

Florida Healthcare Fraud Defense Attorneys

From Jacksonville to Miami, healthcare providers throughout Florida are being targeted in high-stakes federal healthcare 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 healthcare fraud defense lawyers as soon as possible.

Healthcare 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 healthcare 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. Healthcare 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 defense law firm. Contact a Florida healthcare fraud defense attorney from the firm who represents providers across Florida and nationwide. With a team of highly experienced Florida healthcare fraud defense lawyers and former federal prosecutors, we take a strategic and knowledge-based approach to defending clients in all healthcare 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 healthcare 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 healthcare fraud defense lawyers today.

What Is Healthcare Fraud?

As a physician, pharmacist, or other healthcare provider, what does it mean to be accused of healthcare 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 “healthcare 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 healthcare 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 healthcare providers or entities in the investigation as well?

Sources of Authority in Federal Healthcare 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 healthcare benefit programs. This includes intentional and unintentional billing and coding errors as well as various other forms of healthcare 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 healthcare 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 healthcare 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 Healthcare Fraud Statute

The healthcare fraud statute, 18 U.S.C. 1347, makes it a federal offense to “knowingly and willfully” defraud or attempt to defraud any healthcare benefit program or seek to secure payment from a healthcare benefit program by “false or fraudulent pretenses.” 18 U.S.C. 1347 is a criminal statute, and healthcare 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 healthcare fraud investigations in Florida.

7. Other Federal Criminal Statutes

In addition to the federal statutes and regulations that focus specifically on federal healthcare 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
  • Conspiracy
  • Mail and wire fraud
  • Money laundering
  • Tax evasion

5 Reasons Why Healthcare Providers Trust Oberheiden, P.C.’s Florida Federal Healthcare 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 healthcare fraud defense lawyers to represent you in Florida:

  • We will use our vast experience to execute a strategic defense. Our Florida healthcare fraud defense attorneys have centuries of combined legal experience on both sides of federal healthcare 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 healthcare 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.

Frequently Asked Questions

What is the Anti-Kickback Statute?


The Anti-Kickback Statute (AKS) (42 U.S.C. §1320a–7b) is a federal law prohibiting a medical provider from offering, paying, soliciting, or receiving money—or anything else of value—in exchange for patient referrals when the patient’s medical bills are paid by any federally funded program. Most often, these cases involve Medicaid or Medicare. While many cases involving alleged violations of the AKS involve the payment of money for referrals, other common kickbacks include lavish meals, expensive hotel stays or vacations, prestigious or high-paying positions. The AKS is a criminal law and can carry the possibility of incarceration and other criminal sanctions. However, those in violation may also face civil liability under the False Claims Act. If you are facing a violation under the Anti-Kickback Statute, it is crucial you protect yourself by reaching out to a dedicated Florida federal healthcare fraud defense attorney immediately.

What is a whistleblower?


A whistleblower is a person who relates information pertaining to another’s alleged healthcare fraud in hopes of obtaining a monetary reward for doing so. Whistleblower claims are brought under the qui tam provision of the False Claims Act. In most cases, a whistleblower contacts the federal government, providing prosecutors with information about the alleged fraud. Federal prosecutors then interview the whistleblower and conduct their own investigation before determining whether to intervene in the case. Even if the federal government chooses not to get involved, the whistleblower can proceed individually on behalf of the government. Whistleblower claims are often suspect, because a whistleblower can recover as much as 30 percent of the amount recovered. That said, anyone facing allegations of healthcare fraud—even if made by a whistleblower—should consult with a Florida federal healthcare fraud defense attorney as soon as possible.

Does the federal government take whistleblower claims seriously?


Yes, and in some cases, the government will intervene in the lawsuit. When a whistleblower approaches federal investigators with evidence of possible healthcare fraud, the government is obligated to conduct its own investigation. If the allegations are significant and supported by enough evidence, the government may choose to take the case. If the federal government decides not to intervene, that doesn’t mean the case will go away, as the whistleblower has the option to continue with the case at their own expense. Most whistleblowers do this because they stand to recover a portion of the total amount recovered in the event their case is successful. If you are in the middle of a whistleblower’s allegations, contact a knowledgeable Florida federal healthcare fraud defense attorney as soon as possible.

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. The most common examples of Medicare fraud include:

  • 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
  • Overutilization of services or equipment

Healthcare fraud laws also forbid certain referral relationships between practitioners. For example, under the Anti-Kickback Statute (AKS), providers are not permitted to receive anything of value for referring a patient whose medical expenses are paid for by Medicare. If you find yourself involved with a healthcare fraud investigation, contact a Florida federal healthcare fraud defense attorney immediately.

What can I do to avoid federal healthcare fraud charges?


If you are under investigation for healthcare fraud, it is important that you are proactive in your approach to the allegations. While it may seem like there is little you can do to prevent the inevitable, that couldn’t be further from the truth. An experienced Florida federal healthcare fraud defense attorney, can help in several ways. For example, in some cases, federal prosecutors will look at any remedial actions you took to bring your practices back into compliance—even after the investigation was underway. Additionally, a Florida federal healthcare fraud defense attorney can critically examine the government’s case to identify any weaknesses.

Discuss Your Legal Matter with Our Florida Healthcare Fraud Defense Attorneys

If your healthcare business or practice is being targeted by agents from the DOJ, DEA, OIG, or another federal agency, we encourage you to contact our Florida healthcare fraud defense lawyers immediately to schedule a free initial case assessment. To speak with an attorney on our federal healthcare fraud defense team in confidence, please call 888-680-1745 or tell us how we can help online now.

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