South Florida Healthcare Fraud Defense Attorneys
If you are being investigated for healthcare fraud in Southern Florida, you need the experienced federal defense team at Oberheiden, P.C.
Southern Florida Healthcare Fraud Defense Team Lead
Former Deputy Chief, Appellate Division
As the United States government renews its focus on the issues of fraud, waste, abuse, and prescription misuse within the healthcare industry, providers in Southern Florida are being targeted for investigation. Because Miami is home to one of the largest populations of Medicaid / Medicare recipients, the federal government has allocated additional resources to the Southern Florida area, including the Miami-based Medicare Fraud Strike Force office. Healthcare companies and providers working in South Florida may be more likely to come under scrutiny as a result.
What you need to understand is that the early stages of an investigation are extremely important. Don’t make the mistake of thinking it is premature to contact a lawyer. The early stages represent the best opportunity for ending the matter before it matures into a grand jury proceeding or criminal indictment.
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 southern areas of Florida. The attorneys in our firm offer more than 100 years of cumulative legal experience, and several are former federal prosecutors. Our Southern FL healthcare fraud defense attorneys 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). That experience has helped us bring the majority of our clients’ cases to a close with zero criminal charges filed. Let us fight to protect you from the serious threat of criminal prosecution. Call us for a free consultation today.
What Is Healthcare Fraud?
Healthcare fraud can take many forms. Any act of misrepresentation to a healthcare program can constitute healthcare fraud. Prosecutors have their choice of many, many federal statutes that might apply in cases of healthcare fraud. Some statutes apply only when the alleged victim is a federal program (e.g., Medicare, Medicaid, Tricare, the Department of Labor, etc.), while others also apply to the defrauding of a private insurance company. The precise nature of the charges determines the potential penalties in your matter as well as the best strategy for defense. Some of the healthcare fraud allegations that our Southern FL healthcare fraud defense lawyers have defended against at Oberheiden, P.C., 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
When we enter a case, one of our first priorities is to determine two important items of information:
- The nature of the investigation (is it civil or criminal?)
- The specific agencies and/or task forces involved
These two items tell us a lot about what’s happening, what’s at stake, and how our Southern FL healthcare fraud defense attorneys should respond to best protect our clients. We then develop a tailored strategy for the situation at hand, always grounded in our aggressive, tested-and-proven approach to defense.
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 Southern Florida.
1. The False Claims Act
The False Claims Act (FCA) prohibits the submission of “false or fraudulent” claims for payment to any federal benefits program. In most cases, the FCA is invoked in billing discrepancies with Medicaid, Medicare, or Tricare. Unfortunately, our Southern FL healthcare fraud defense lawyers have seen many instances throughout the Sunshine State where a healthcare practice has made simple clerical errors or good-faith mistakes of judgment that were later misconstrued by law enforcement agents as evidence of criminal fraud. The penalties can be steep. FCA penalties are applied per claim, so the toll of each fine and reimbursement can quickly add up to an effectively unpayable sum. Additional consequences of FCA violation can include exclusion from federal benefits programs and/or prison sentences.
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) makes it a crime to offer, solicit, pay for, or receive a referral fee (or any other form of “remuneration”) in exchange for referring a Medicare, Medicaid, Tricare, or DOL beneficiary. The statute’s prohibitions extend to a wider range of business arrangements than many people realize. Indeed, we have helped many clients who were utterly shocked to find themselves accused of violating the Anti-Kickback Statute. AKS violations may result in civil and/or criminal penalties, depending on the circumstances.
3. The Stark Law
Under the federal Stark Law, it is illegal for physicians to “self-refer.” Here again, the statute covers a broader range of conduct than is apparent at first glance. We have helped many physicians who were only trying to help their patients by referring them to the best-available source of care – only to later learn that the referral constituted an alleged violation of the Stark Law. A Southern FL healthcare fraud defense lawyer at Oberheiden, P.C. is available to assist physicians or entities accused of Stark Law violations.
4. The Controlled Substances Act (CSA)
The Controlled Substances Act is a complex and multifaceted statute. This same law is used to put away illicit drug dealers, to regulate prescription medications and those who prescribe them, and to target healthcare professionals for criminal prosecution. Common allegations made under the CSA include:
- Prescribing medications unnecessarily
- Providing addictive drugs to patients with a history of abuse
- Misappropriating prescription substances
- “Selling” prescriptions
- Pharmaceutical fraud
- Other unlawful practices
5. The Federal Healthcare Fraud Statute
18 U.S.C. 1347 is a broad and far-reaching statute that is most widely referred to as simply “the healthcare fraud statute.” It makes it a crime to:
The broad language here gives prosecutors considerable discretion. Nevertheless, our proven Southern FL healthcare fraud defense lawyers have a track record of avoiding or defeating such healthcare fraud allegations in the majority of our cases.
6. Other Fraud Statutes
In addition to the criminal statutes described above, healthcare providers frequently face allegations of wire fraud, mail fraud, forgery, making false statements, federal conspiracy to commit healthcare fraud, and 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 lead to overwhelming penalties. Care providers in Southern FL can mitigate the risk of prosecution by maintaining a compliance program.
8. DOJ Mandates
Department of Justice mandates 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. Case in point: the recent launch of both the Prescription Interdiction & Litigation (PIL) Task Force and the Opioid Fraud and Abuse Detection Unit.
5 Reasons to Trust Oberheiden, P.C. and Our Southern FL Federal Healthcare Fraud Defense Lawyers
Here are five reasons why healthcare providers and other Medicare, Medicaid, and Tricare participants in Southern FL should choose Oberheiden, P.C., as their federal healthcare fraud defense lawyer:
- Our Extensive Experience in Healthcare Fraud Investigations – We have handled thousands of federal healthcare fraud audits, investigations, and prosecutions on behalf of healthcare providers in Southern FL and nationwide.
- Our Record of Avoiding Charges – In the majority of our cases, our Southern FL healthcare fraud defense lawyers have reached a resolution in which our client ultimately does not face criminal charges.
- Our Focus on Federal Healthcare Fraud Defense – Much of our defense work is concentrated in the highly specific area of federal healthcare fraud defense. We have represented physicians, pharmacists, clinics, laboratories, hospitals, hospices, and virtually every other category of healthcare providers.
- Our Experience on Both Sides – Oberheiden, P.C., is comprised of both long-established federal defense attorneys and deeply experienced former federal prosecutors. 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, precisely because the stakes are so high. A Southern FL healthcare fraud defense attorney at Oberheiden, P.C. also offers an Emergency Defense Package for urgent legal crises.
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
What is the Anti-Kickback Statute?
The Anti-Kickback Statute (AKS), codified in 42 U.S.C. §1320a–7b, is a federal law that prohibits certain referrals for patients receiving government benefits through Medicare, Medicaid or other federally funded programs. The AKS forbids the offering, paying, soliciting, or receiving anything of value in exchange for patient referrals. Although cash referrals form the basis of most AKS violations, the statute covers the exchange of anything of value. This includes, for example, lavish vacations, meals, or even employment opportunities. The AKS is a criminal statute, and a conviction carries the possibility of incarceration –– up to five years in state prison per offense –– along with 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 imperative that you protect yourself by contacting a dedicated Southern Florida federal healthcare fraud defense attorney as soon as possible.
What is at stake in a federal healthcare fraud lawsuit?
A violation of a federal healthcare fraud law can result in either civil or criminal liability or, in some cases, both. Some statutes provide for only civil liability, some for only criminal liability, and others provide for civil or criminal liability, depending on the circumstances. In a civil healthcare fraud case, the punishments typically from significant fines and professional sanctions, such as being barred from participating in federally funded programs such as Medicare or Medicaid. Criminal healthcare fraud cases can result in these consequences, as well as the possibility of incarceration. If you recently learned that you are at the center of a healthcare fraud investigation, it is important to reach out to a Southern Florida federal healthcare fraud defense attorney as soon as possible to learn more about the allegations and what you can do to defend against them.
When should I reach out to a Southern Florida federal healthcare fraud defense attorney?
The general rule is, the sooner you contact a Southern Florida federal healthcare fraud defense attorney, the better. There are a few reasons why this is the case. First, when you first learn of federal healthcare charges it may not be clear whether you are facing civil or criminal liability. An experienced attorney will know the questions to ask investigators to determine what exactly you are facing. From there, a skilled Southern Florida federal healthcare fraud defense attorney will focus on eliminating the possibility of criminal liability. Once criminal liability is off the table, you have a little more breathing room and can focus on defending against the civil charges. If you are under investigation for federal healthcare fraud, reach out to a Southern Florida federal healthcare fraud defense attorney as soon as possible. The sooner you reach out to a lawyer, the more options they wil have to favorably resolve the case.
Discuss Your Federal Healthcare Fraud Investigation in Confidence
If your Southern FL healthcare practice or company is being targeted in a federal healthcare fraud investigation, our Southern FL healthcare fraud defense attorneys strongly encourage you to contact us for a confidential case assessment. To speak with a member of our federal defense team for free, call 888-680-1745 or inquire online, right away.