Orlando Healthcare Fraud Defense Lawyers
What does it mean to be targeted in a federal healthcare fraud investigation? Depending on the allegations against you, you could be facing fines, program exclusion, loss of licensure and registration, and even federal imprisonment. For a free and confidential case assessment, call our Orlando healthcare fraud defense lawyers at 888-680-1745 now.
Facing a federal healthcare fraud investigation is a serious matter, and authorities such as the Department of Justice (DOJ), Drug Enforcement Administration (DEA), Office of Inspector General (OIG), and the Medicare Fraud Strike Force are increasingly targeting providers in Orlando and other major cities throughout Florida. While these investigations are often misguided, physicians, pharmacists, and other providers who fail to defend themselves effectively can still face reputational damage, financial penalties, loss of program eligibility, and in some cases, even the potential for federal incarceration.
At Oberheiden, P.C., we provide strategic and effective legal representation for healthcare providers facing federal investigations in Orlando, FL. Our team, which is comprised entirely of highly experienced defense attorneys and former senior federal prosecutors, has represented thousands of clients in healthcare fraud investigations across the country. Whether you are being targeted for improperly billing Medicaid or Tricare or for using Medicaid-reimbursed funds to pay illegal “kickbacks” or referral fees, you have defenses available. Our Orlando healthcare fraud defense lawyers can use these defenses to protect you against unwarranted prosecution.
In federal healthcare fraud investigations, prompt intervention and a proactive defense strategy are the keys to avoiding costly consequences. If at all possible, you want to resolve your case before it leads to federal charges. We have resolved the vast majority of our clients’ investigations without charges being filed and effectively protected our clients against criminal indictments.
What Is Healthcare Fraud?
“Healthcare fraud” is a surprisingly complicated term. Unlike other forms of fraud – like bank fraud, mortgage fraud, and insurance fraud – healthcare fraud is not one single clearly defined offense. Instead, “healthcare fraud” is a broad term which describes a variety of different civil and criminal offenses, which are unified by the fact that they involve improperly obtaining funds from a federal healthcare benefit program.
This presents certain challenges in DOJ, DEA, OIG, and Medicare Strike Force investigations. In order to defend yourself effectively, you first need to know exactly what you need to defend against. Yet, facing allegations of “healthcare fraud” could mean facing allegations ranging from:
- Overbilling Medicare, Medicaid, Tricare, or the Department of Labor (DOL) healthcare benefit program
- Billing Medicare, Medicaid, Tricare, or the DOL for medically-unnecessary services or supplies
- Billing Medicare, Medicaid, Tricare, or the DOL for services or supplies not actually rendered to patients
- Offering, paying, soliciting, or accepting an illegal “kickback” or referral fee
- Improperly prescribing, administering, or dispensing prescription medications (such as prescription opioids)
- Falsifying patient records, prescriptions, physician certifications, and election statements
In order to find out why you are under investigation, you need to effectively intervene in the government’s investigation. This requires the services of an experienced and highly capable defense team. All of our healthcare fraud defense lawyers in Orlando are experienced in intervening in federal healthcare fraud investigations on behalf of our clients, and we can quickly make contact with the federal agents and prosecutors handling your investigation to determine:
- What specific allegations triggered the investigation?
- What was the source of the original allegations?
- Is anyone else under investigation?
- How long has the investigation been ongoing?
- What evidence has the government collected to date?
- Is the investigation currently civil or criminal in nature?
Once we have this information, our Orlando healthcare fraud defense attorney can then develop a customized and comprehensive case strategy designed to favorably resolve the investigation as quickly and with as little publicity as possible.
1. The False Claims Act
The False Claims Act (FCA) prohibits the submission of any “false or fraudulent” claim for payment by the federal government. This includes both intentional and unintentional “false” claims, with intentional claims having the potential to lead to criminal charges. Most federal healthcare fraud investigations involve allegations under the FCA. And with each individual billing constituting a separate claim, providers can often face hundreds of thousands, if not millions, of dollars in financial penalties.
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) prohibits the offer, payment, solicitation, or receipt of referral fees or other forms of “remuneration” in connection with Medicare, Medicaid, Tricare, and DOL beneficiary referrals. While the AKS’s prohibitory language is extremely broad, there are numerous “safe harbors” that can provide insulation from liability under a variety of different narrowly-prescribed circumstances. Similar to the False Claims Act, the AKS includes provisions for civil and criminal penalties.
3. The Stark Law
The Stark Law prohibits so-called “physician self-referrals.” Unlike the False Claims Act and the Anti-Kickback Statute, the Stark Law is exclusively civil in nature. It also only applies to physicians and their related entities, and only to transactions involving “designated health services.” Nonetheless, the Stark Law can still expose physicians to substantial liability under a variety of different circumstances.
4. The Controlled Substances Act
The Controlled Substances Act is the primary statute that the DEA uses to investigate and prosecute healthcare providers suspected of engaging in pharmaceutical fraud. The DEA targets both registered and unregistered healthcare providers, and it is currently placing particular emphasis on targeting providers who prescribe, administer, and dispense opioid medications.
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.” Orlando healthcare providers singled out for prosecution under 18 U.S.C. 1347 can face enormous fines and the potential for 10 years, 20 years, or even life in federal prison.
6. Program Billing Regulations
The Medicare, Medicaid, Tricare, and DOL billing regulations are dense, complicated, and difficult to interpret. Yet, providers are expected to maintain strict compliance, and even minor missteps can lead to drastic consequences. Violations of program billing regulations can be prosecuted under the False Claims Act and the other statutes discussed above, and providers who fail to implement comprehensive compliance programs will be particularly at risk for large-scale enforcement actions involving scrutiny of several years’ worth of program billing.
7. DOJ Mandates
The Department of Justice routinely issues releases identifying new law enforcement priorities and task forces. With increasing frequency, these initiatives are targeting healthcare providers and medical businesses in populous cities like Orlando, FL. Task forces such as the Opioid Fraud and Abuse Detection Unit and the Prescription Interdiction & Litigation (PIL) Task Force pool the resources of multiple agencies, and they are aggressively targeting healthcare providers in Florida and nationwide.
5 Reasons Healthcare Providers Choose the Orlando Healthcare Fraud Defense Lawyer at Oberheiden, P.C.
If your Orlando medical practice or healthcare business is under investigation by federal authorities, you need to speak with an experienced defense attorney as soon as possible. At Oberheiden, P.C., we put an entire team of federal healthcare fraud defense attorneys on your side. Our attorneys work together to craft and execute customized defense strategies designed to protect our clients as efficiently and thoroughly as possible. And they do so relying on the knowledge gained from thousands of federal investigations and hundreds of federal trials.
What else you can expect when you choose Oberheiden P.C. for your federal healthcare fraud investigation in Orlando, FL?
- Aggressive Intervention – The sooner we can learn the facts of your case, the better. Our Orlando healthcare fraud defense attorneys will aggressively intervene in the government’s investigation so that we can start building a strategic defense immediately.
- Focus on Resolution Prior to Charges – All of our initial efforts will be on securing a favorable resolution prior to charges being filed. The reason for this is simple: If you aren’t charged, you can’t be convicted.
- Strategic Pretrial Practice – If federal prosecutors decide to file civil charges or seek an indictment, we will work strategically to fight the charges and convince the DOJ that it does not have a case to take to trial.
- Savvy Trial Representation – If the circumstances of your case are such that going to trial is your best option, our Orlando healthcare fraud defense attorneys will use their vast collective federal trial experience to fight for a “not guilty” verdict in court.
- Personalized Professional Representation – Regardless of the circumstances of your case, we will provide personalized and professional representation, guided by our attorneys’ centuries of combined experience representing sophisticated clients in high-stakes federal matters.
Frequently Asked Questions
What is the difference between the Anti-Kickback Statute and the Stark Law?
Although both the Anti-Kickback Statute (AKS) and the Stark Law deal with physical referrals, the two laws have some critical differences. The Anti-Kickback Statute forbids anyone from paying or receiving a referral fee related to a patient whose medical bills are covered by a federally funded program, such as Medicare or Medicaid. The Stark Law focuses on eliminating self-referrals, which are those that involve a physician’s referral to another provider for which they share an economic interest. The Anti-Kickback Statute is a criminal law, carrying maximum penalties of up to five years in jail and a fine of $25,000 per violation. The Stark Law is a civil statute, carrying a maximum penalty of up to $15,000 per violation. Furthermore, anyone who violates either statute may be precluded from participating in Medicare or Medicaid. If you are under investigation for a violation of the Anti-Kickback Statute of the Stark Law, it is imperative you contact a dedicated Orlando, Florida federal healthcare fraud defense lawyer as soon as possible.
Can whistleblowers bring federal healthcare charges?
Yes, under the False Claims Act an individual who has knowledge of a potential violation of federal healthcare fraud laws can bring a whistleblower lawsuit. Oftentimes, however, the whistleblower will first approach federal prosecutors to determine if the federal government wants to adopt, or intervene in the case. If so, the federal government takes over. The whistleblower can proceed on their own on behalf of the government if federal prosecutors decline to prosecute. The incentive for whistleblowers is they can recover a whistleblower’s reward, which can be as much as 30 percent of the amount recovered. If you learned that a whistleblower is making allegations of healthcare fraud against you or your practice, it is important you take the allegations seriously and contact an Orlando federal healthcare fraud defense attorney as soon as possible.
Who investigates DEA opioid cases in Orlando, Florida?
Orlando is one of the hotspots of DEA opioid investigations. Pursuant to instructions from Washington D.C., federal prosecutors and DEA Diversion Investigators in Florida have begun to systematically scrutinize physician offices in the state in their attempts to identify the main prescribers of opioids, benzodiazepines, stimulants, sedatives, and muscle relaxants. The DEA is assisted by the Department of Justice, the U.S. Attorney’s Office, the Office of Inspector General, the Department of Health and Human Services, and the FBI.
Schedule a Free Case Assessment at Oberheiden, P.C.
For more information about our federal healthcare fraud defense team’s practice, please contact our Orlando healthcare fraud defense attorneys to schedule a confidential initial case assessment. You can reach us by phone 24/7 at 888-680-1745, or submit a confidential inquiry online and a member of our team will be in touch as soon as possible.