Northern Florida Healthcare Fraud Defense Lawyers
If you are being investigated for healthcare fraud in Northern Florida, you need the experienced Northern Florida Healthcare Fraud Defense Lawyers at Oberheiden, P.C.
Oberheiden, P.C., is a federal healthcare fraud defense firm that represents healthcare professionals, corporate officers, owners, and business entities in both civil and criminal investigations in the norther areas of Florida.
It is more important now than ever that healthcare providers in North Florida be able to access aggressive and experienced defense – not only because relatively few criminal defense law firms focus almost exclusively on white-collar federal criminal defense, but also because federal agents are currently targeting the healthcare industry as never before.
The Northern Florida healthcare fraud defense lawyers at Oberheiden, P.C., offer more than 100 years of cumulative legal experience, as well as a long track record of persuading federal agents and prosecutors not to file charges against the majority of our clients or to drop them if charges were already filed.
Several of our lawyers are former federal prosecutors. We also have extensive experience in negotiating directly with agencies like the Drug Enforcement Administration (DEA) and the Department of Health and Human Services Office of the Inspector General (DHSS – OIG).
What Is Healthcare Fraud?
There are many ways to commit healthcare fraud under federal law. Congress has enacted numerous criminal statutes aimed at the problem of fraud, waste, and abuse in healthcare. Many of these laws carry severe penalties. Prosecutors are notorious for pursuing the largest number of counts and charges possible and for seeking the harshest possible sentences. That’s why an aggressive criminal defense against any accusation of healthcare fraud is so important.
Some of the healthcare fraud allegations that our team has defended against include:
- Billing fraud (Medicare, Medicaid, Tricare, etc.)
- Department of Labor (DOL) fraud
- Anti-Kickback Statute violations
- Stark Law violations (physician self-referral)
- Controlled Substances Act / DEA registration violations (including prescription drug fraud)
- Providing / Billing for medically unnecessary services
- Billing for services not actually rendered to patients
- Falsifying patient records, prescriptions, physician certifications, or election statements
Details matter. The specific circumstances of your investigation dictate which defense strategies will serve you best. To determine which kind of healthcare fraud matter we’re really dealing with, we try to learn two key pieces of information right away:
- Is the investigation currently oriented toward a civil enforcement proceeding or a criminal prosecution?
- Which federal law enforcement agencies and/or task forces are involved?
By answering those questions, we can determine where your investigation currently stands and, accordingly, your best opportunity for avoiding and defeating prosecution (or devastating civil fines).
The Most Commonly Invoked Healthcare Fraud Laws
Below, we review just a handful of the most common statutes, laws, regulations, and directives that result in the criminal prosecution of healthcare professionals in Northern Florida.
1. The False Claims Act
The False Claims Act (FCA) is also known as “The Lincoln Law,” so called because it was enacted in 1863 under the presidency of Abraham Lincoln. The law has been modified many times since then and has only given the government more power with time. Among other things, the FCA makes it a crime to submit “false or fraudulent” payment claims to a federal benefits program such as Medicaid or Medicare. The FCA also contains qui tam provisions, incentivizing private whistleblowers whose civil claims on the government’s behalf can trigger criminal investigations as well. FCA penalties are applied per claim, so they can add up to a very large dollar amount, very quickly. Additional consequences may include exclusion from federal benefits programs under the CMS or other agencies, not to mention a potential prison sentence.
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) applies civil and/or criminal penalties to healthcare providers who offer, solicit, pay for, or receive remuneration (for example, a referral fee) in exchange for referring a government health program beneficiary. While the term “kickback” might seem self-explanatory, the government has brought AKS charges against numerous providers whose conduct did not readily appear to be a “kickback” so much as a common-sense and good-faith business arrangement. If you have been accused of violating the AKS, you should contact our office right away.
3. The Stark Law
The Stark Law makes it unlawful for a physician to make “self-referrals.” With the Stark Law, the government hopes to preclude doctors from gaming the system by profiting from their own referrals. But while that might sound sensible in theory, in practice, the government has used the statute aggressively, often resulting in unfair and excessive financial penalties for healthcare providers who were only trying to get their patients the best care they could. Our Northern Florida healthcare fraud defense attorneys are available to assist any physicians or healthcare businesses accused of Stark Law violations in Northern FL.
4. The Controlled Substances Act (CSA)
The Controlled Substances Act established the United States’ federal drug policy. It regulates the manufacture, distribution, importation, possession, and usage of a wide variety of substances, including illegal drugs and prescription medications. The DEA frequently investigates healthcare providers in Northern Florida in a wide variety of CSA-related matters, including:
- Pharmaceutical fraud
- Prescribing unnecessary medication
- Diverting opioids or other prescription drugs
- “Selling” prescriptions
- Providing addictive drugs to addicted patients
- Other unlawful prescription practices
Most “pill mill” or “pain mill” investigations in Northern Florida pertain to the Controlled Substances Act.
5. The Federal Healthcare Fraud Statute
18 U.S.C. 1347 contains the country’s general “healthcare fraud statute,” which makes it illegal to:
“knowingly and willfully execute, or attempt to execute, a scheme or artifice –
(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.”
Owing to the broad nature of its plain text, 18 U.S.C. 1347 might appear on a list of charges in virtually any healthcare fraud case in North Florida.
6. Other Fraud Statutes
In addition to the criminal statutes described above, healthcare providers frequently face allegations of other charges, including:
- Wire fraud
- Mail fraud
- Making false statements
- Federal conspiracy
- Wrongful use of health information
- Other serious charges
7. Program Billing Regulations
Federal healthcare benefits programs establish their own rules and regulations, the violation of which (even if unintentional) may have extremely serious consequences. These program billing regulations change with some frequency, making compliance a challenge. Care providers in Northern FL can mitigate their risk of prosecution by maintaining an active, up-to-the-minute compliance program.
8. DOJ Mandates
Mandates from the Department of Justice are public announcements or internal instructions about which kinds of cases DOJ agents should prioritize. Currently, healthcare fraud and opioid diversion are among the Department’s top priorities. In fact, the Department recently announced the creation of two new collaborative task forces within a matter of mere months: the Opioid Fraud and Abuse Detection Unit, and the Prescription Interdiction & Litigation (PIL) Task Force.
5 Reasons to Trust the Northern Florida Healthcare Fraud Defense Attorney at Oberheiden, P.C.
Here are five reasons why healthcare providers and other Medicare, Medicaid, and Tricare participants should choose Oberheiden, P.C., as their Northern Florida healthcare fraud defense lawyer:
- Our Extensive Experience in Healthcare Fraud Investigations – Our Northern Florida healthcare fraud defense attorneys have handled thousands of federal healthcare fraud audits, investigations, and prosecutions on behalf of healthcare providers in FL and nationwide.
- Our Record of Avoiding Charges – In the majority of our cases, our have been able to end criminal investigations without the filing of criminal charges.
- Our Focus on Federal Healthcare Fraud Defense – Healthcare fraud defense is one of our principal focuses as a law firm. Our skilled Northern Florida healthcare fraud defense lawyers have represented physicians, pharmacists, clinics, laboratories, hospitals, hospices, and virtually every other category of healthcare provider.
- Our Experience on Both Sides – Several of the senior defense attorneys on our team are also former federal prosecutors, having spent years or decades working for the other side. We believe this “dual perspective” helps us negotiate efficiently and effectively with current federal prosecutors.
- Our Aggressive Defense Strategies – We take an aggressive approach to defending our clients in every single case. We understand that the incredibly high stakes demand that our dedicated Northern Florida healthcare fraud defense attorneys give all our passion and energy to every case, every day.
Don’t make the mistake of facing the federal criminal justice system on your own. Choosing the right law firm could become the most important decision you will ever make.
Frequently Asked Questions
Which federal agencies are responsible for investigating healthcare fraud allegations?
While every healthcare fraud investigation is different, the Federal Bureau of Investigations is typically the agency that spearheads most cases. However, the FBI relies on the assistance of many other federal agencies, including the following:
- The Office of Inspector General (OIG)
- The Centers for Medicare and Medicaid Services (CMS)
- The Department of Health and Human Services (HHS)
- The Department of Defense (DOD)
- The Drug Enforcement Administration (DEA)
- The Department of Justice (DOJ)
- The Department of Labor (DOL)
Often, while in the process of conducting regular business, one of these agencies comes across information that raises a red flag. It may be that an audit didn’t go well or that a whistleblower reached out to the agency after discovering what they believed to be evidence of fraud. The agency receiving this information may then conduct its own internal investigation. However, as soon as the agency believes that the subject of the investigation committed wrongdoing, it will typically get the FBI involved. If you are under investigation by the FBI or any other federal agency, it is imperative that you protect yourself and your business by contacting a Florida federal healthcare fraud defense attorney.
What does “qui tam” refer to?
Qui tam is a Latin phrase that relates to a civil case filed by an individual on behalf of the government. In the context of healthcare fraud claims, a qui tam lawsuit can be brought under the False Claims Act. More specifically, when a person comes across evidence they believe is indicative of healthcare fraud, they can either file a case on their own or present the evidence to federal investigators. In some cases, the federal government will determine that it will intervene in the lawsuit, taking over the case. In others, the federal government will choose not to intervene. At this point the whistleblower, or relator, has the choice of pursing the claim on their own. If a whistleblower’s claim results in any award, they are entitled to a portion of the amount recovered, up to 30 percent. While qui tam lawsuits raise some serious concerns due to the financial incentives offered to whistleblowers, if you are facing a whistleblower lawsuit you must take the situation seriously by contacting a Northern Florida federal healthcare fraud defense attorney.
Should I speak with investigators about a healthcare fraud claim?
No––at least not without speaking to an experienced Florida federal healthcare fraud defense attorney first. To be sure, communicating, and even cooperating with federal investigators is not something that should be ruled out in every case. However, the risks of doing so on your own are simply too great. When you speak with investigators, everything you say will be documented. Therefore, if you leave out small—but important—details, or make an innocent misstatement of fact, it can be taken as evidence of wrongdoing. It is a better idea and much safer to speak with a Northern Florida federal healthcare fraud defense attorney to determine the extent of the investigation before responding to federal investigators.
Discuss Your Federal Healthcare Fraud Investigation in Confidence
If your Northern FL healthcare practice or company is being targeted in a federal healthcare fraud investigation, we strongly encourage you to contact us for a confidential case assessment. To speak with our Northern Florida healthcare fraud defense attorneys for free, call 888-680-1745 or inquire online, right away.