Tallahassee Healthcare Fraud
Federal agents are currently going after healthcare providers in Tallahassee, FL, (and elsewhere in Florida) in a series of high-stakes criminal investigations. If your business or medical practice is being investigated, you need the experienced federal defense team at Oberheiden, P.C., on your side. The words “healthcare fraud” have become a household phrase in recent years, thanks in large part to sensational headlines about major “busts” of healthcare companies and white-collar professionals in the medical industry. Indeed, the ever-aggressive Department of Justice (DOJ) and Department of Health and Human Services (DHHS) are cracking down on the healthcare industry like never before. Each week brings stories of new arrests, and many of those have come out of Tallahassee and Florida’s other major metropolitan areas. Agents from both the DEA (the law enforcement arm of the DOJ responsible for policing controlled substances) and the OIG (the law enforcement arm of the DHHS) are active in Tallahassee. Any person or business submitting claims for payment to a federal health benefits program in Florida’s capital should be very vigilant. The attorneys at Oberheiden, P.C., are backed by their more than a century’s worth of legal experience. Several of our attorneys have backgrounds as federal prosecutors at the Department of Justice or in other federal prosecutors’ offices before transitioning to private legal defense. In the majority of our cases, our Tallahassee healthcare fraud attorneys have been able to avoid the filing of criminal charges against our healthcare clients. While we cannot promise specific outcomes in advance, we will fight to protect your medical licenses and DEA registration, with the goal of keeping you in practice, out of prison, and avoiding exorbitant fines.
What Is Healthcare Fraud?Healthcare fraud is broadly defined, owing in part to the large number of federal statutes aimed squarely at the healthcare industry. There are many kinds of healthcare fraud. Some common examples 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
The Most Commonly Invoked Healthcare Fraud LawsBelow, we review just a handful of the most common statutes, laws, regulations, and directives that result in the criminal prosecution of healthcare professionals in Tallahassee, FL.
1. The False Claims ActThe False Claims Act (FCA) is a major piece of federal legislation aimed directly at the healthcare industry. Under the FCA, it is a crime to make “false or fraudulent” claims for payment (including false or “phantom” bills) to any federal health benefits program. The penalties for violating the FCA apply each time you submit a false or fraudulent claim. Because the government tends to prosecute these claims after a long pattern of billing discrepancies, the allegations can add up to a staggering sum. Additional penalties include program exclusion and/or a federal prison sentence.
2. The Anti-Kickback StatuteThe Anti-Kickback Statute (AKS) is another major federal healthcare criminal statute. Under the AKS, it is a crime to offer, pay, solicit, or receive of any kind of remuneration, incentive, or reward in exchange for referring a patient for healthcare services. It applies when the patient is a federal beneficiary, such as a Medicare or Medicaid recipient. The AKS provides for both civil and criminal penalties.
3. The Stark LawThe Stark Law is narrower in scope than the statutes we’ve discussed so far. It applies specifically to “physician self-referrals,” which are illegal under the Stark Law and can result in significant civil penalties.
4. The Federal Healthcare Fraud StatuteMany federal healthcare fraud indictments include at least one count of violating 18 U.S.C. 1347, better known as the “healthcare fraud statute.” This statute, which is broadly written and applied, reads (in part) as follows:
(a) “Whoever knowingly and willfully executes, or attempts to execute, a scheme or artifice –
(1) to defraud any healthcare benefit program; or (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, in connection with the delivery of or payment for healthcare benefits, items, or services, shall be fined under this title or imprisoned not more than 10 years, or both…”
5. The Controlled Substances Act (CSA)The Controlled Substances Act is well known as the primary law governing drugs in this country – not only prohibited drugs but also medicinal substances that require a doctor’s prescription. The CSA is frequently used to investigate and prosecute healthcare providers who are suspected of: writing unnecessary prescriptions, selling prescriptions or selling medications, committing pharmaceutical fraud, giving drugs to patients with a history of substance abuse, diverting painkillers, or other unlawful practices. Most “pill mill” investigations in Tallahassee pertain to the Controlled Substances Act.
6. Other Fraud StatutesIn addition to the criminal statutes described above, healthcare providers in Tallahassee may face allegations of other related charges. These include:
- Wire fraud
- Mail fraud
- Making false statements
- Federal conspiracy
- Wrongful use of health information
7. Program Billing RegulationsThe above statutes notwithstanding, healthcare benefits agencies such as the CMS may establish their own rules and regulations. Violating these program billing regulations may have extremely serious consequences, even if there is no evidence of intent (whereas most healthcare fraud statutes do require proof of intent). Care providers in Tallahassee can mitigate their risk of prosecution by maintaining a proactive compliance program.
8. DOJ MandatesFrom time to time, the U.S. Department of Justice issues new departmental mandates. These are often attempts to curry favor with the public, assuring voters that federal agents are remaining “tough on crime.” Political polls often show that the public is very concerned about taxpayer fraud, waste, and abuse. Accordingly, DOJ mandates often target those kinds of crimes. And because arresting successful white-collar professionals attracts media attention, it is not uncommon for DOJ mandates to target healthcare specifically. Indeed, the DOJ recently announced two task forces to that end: the Opioid Fraud and Abuse Detection Unit, and the Prescription Interdiction & Litigation Task Force (PIL).
5 Reasons to Choose Oberheiden, P.C., and Our Tallahassee Federal Healthcare Fraud Defense LawyersHere are five reasons why healthcare professionals and business entities in the Tallahassee area should trust Oberheiden, P.C., as their federal healthcare fraud defense attorneys:
- Our Extensive Experience in Healthcare Fraud Investigations – There is no substitute for experience. Our Tallahassee healthcare fraud attorneys have represented providers and business entities in thousands of federal healthcare fraud audits, investigations, and criminal cases.
- Our Record of Avoiding Charges – While we can never guarantee a particular outcome in advance, we are proud to have avoided criminal charges for most of our healthcare clients. Make no mistake: avoiding charges is the most effective way to resolve a criminal investigation, and that is the goal we fight toward whenever possible.
- Our Focus on Federal Healthcare Fraud Defense – While we handle many types of white-collar defense, healthcare fraud defense has long been one of our primary areas of professional focus. Our healthcare fraud defense lawyers are available to represent physicians, pharmacists, clinics, hospitals, hospices, medical laboratories, mobile labs, ambulance providers, diagnostic companies, and virtually every other category of healthcare provider.
- Our Experience on Both Sides – Several of the Tallahassee healthcare fraud attorneys at Oberheiden, P.C., are former federal prosecutors, having spent years or decades working in the DOJ or other prosecutorial positions.
- Our Aggressive Defense Strategies – When the stakes are high, you need attorneys who will fight for you as if their own freedom depended on it. We believe in taking an aggressive approach. Every time.
Discuss Your Federal Healthcare Fraud Investigation in ConfidenceIf your healthcare practice or company is being targeted in a federal healthcare fraud investigation, our proven Tallahassee healthcare fraud 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.
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