Guam Health Care Fraud Defense Lawyers
Our federal health care fraud defense lawyers represent providers in Guam as well as those who provide telemedicine services to Guam residents, including military personnel. If you are being accused of defrauding a federal health care benefit program or diverting opioid medications, it is important that you speak with a lawyer promptly.
Although Guam may be far from the U.S. mainland, it isn’t off of federal authorities’ radar. In late 2019, the U.S. Department of Justice (DOJ) announced one of the largest ever Medicare and Tricare ambulance fraud cases nationwide – targeting a service provider headquartered in Guam. Other recent cases have targeted physicians, pharmacists, telemedicine companies, and other types of providers, and those that have been charged criminally have faced enormous fines and years or decades behind bars.
Federal Authorities are Targeting Health Care Fraud in Guam
While Guam is perhaps most well-known as a U.S. military outpost, its population consists of both military and non-military residents. Health care facilities on the island serve patients of all ages and all walks of life, although a common thread among many patients is that they are beneficiaries under federal health care benefit programs. This includes Medicare, Medicaid, Tricare, and Veterans Affairs (VA) benefits – all of which serve as critical lifelines to beneficiaries and participating providers, and all of which are subject to strict oversight and comprehensive rules and regulations.
A fairly recent development that has had a major impact on health care providers in Guam and on the U.S. mainland is the government’s heavy reliance on data analytics. While providers in Guam may have previously flown under the radar, this is no longer the case. When it comes to facing scrutiny due to “red flags” in Medicare, Medicaid, Tricare, and VA billing data, in today’s world all providers are on a level playing field. If a provider’s data suggest fraudulent billing or prescription practices, federal agents will investigate – no matter where the investigation takes them.
Federal Health Care Fraud Defense Lawyers Representing Providers in Guam and Nationwide
The federal health care fraud defense lawyers at Oberheiden, P.C. represent health care providers in Guam and nationwide. With a nationwide presence and attorneys who have centuries of combined experience as federal prosecutors and defense counsel, we are able to efficiently and effectively represent providers in Guam as well as those who provide services in Guam from the U.S. mainland. With thousands of cases successfully resolved, we have the insights and reputation providers need when they are facing the prospect of civil enforcement or criminal prosecution in Guam.
Matters We Handle in Guam and on the U.S. Mainland
Our practice encompasses providing defense representation for all federal health care fraud matters. From civil accusations of “upcoding” and “unbundling” to criminal allegations of accepting illegal kickbacks and diverting opioid medications, all types of cases have the potential for severe consequences. When you contact us about your case, we will promptly assess your risk, and we will work to quickly develop and implement a custom-tailored defense strategy.
Some of the most-common types of matters we handle in Guam and on the U.S. mainland include:
Health Care Benefit Program Audits
Many providers’ first introduction to the federal health care law enforcement regime is a program audit. Auditor contractors and personnel working for the Centers for Medicare and Medicaid Services (CMS), the U.S. Department of Defense (DOD), and the VA routinely conduct audits focused on uncovering overpayments from Medicare, Medicaid, Tricare, and the VA. While these are referred to as “audits” and they are civil in nature, they can ultimately lead to the same consequences as agency investigations.
DOJ, FBI, and OIG Health Care Fraud Investigations
The DOJ, the Federal Bureau of Investigation (FBI), and the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) are the agencies that are primarily responsible for investigating federal health care benefit program fraud. If a provider’s billing data contain “outliers” or other “red flags” for program fraud, this alone can be enough to trigger an invasive inquiry. DOJ, FBI, and OIG health care fraud investigations can be either civil or criminal in nature, and they can target a broad range of federal offenses.
DEA Prescription Drug Fraud Investigations
Another major risk for health care providers that prescribe and dispense prescription medications is the risk of being targeted by the Drug Enforcement Administration (DEA). The DEA conducts routine inspections of registered providers, and it also conducts ad hoc criminal investigations under the Controlled Substances Act (CSA). Opioid-related offenses are currently high on the DEA’s radar; however, any prescription-drug related offense can lead to a DEA investigation and subsequent prosecution by the DOJ.
Whistleblower Investigations and Litigation
Along with the government’s automated review of program-participating providers’ billing data, whistleblower claims are the other primary trigger of federal health care fraud investigations. We have significant experience representing providers faced with whistleblower allegations during the government’s investigation and during the pre- and post-intervention stages. Whistleblower cases present unique challenges and opportunities, and our attorneys are skilled at helping clients survive potentially-dangerous allegations.
Health Care Compliance Failures
For health care providers in Guam (and elsewhere nationwide), proactive compliance is the key to avoiding substantial penalties in the event of an audit or investigation. In addition to our federal defense practice, we provide federal health care compliance representation as well, and we are fully aware of the burdens facing program-participating health care providers. As a result, we know that mistakes can – and do – happen, and we know what it takes to successfully defend clients in cases involving inadvertent billing errors and other statutory and regulatory violations.
10 Examples of Health Care Fraud Offenses
So, your health care practice or medical business is being targeted in an audit or investigation. What exactly are the auditors or investigators looking for?
In order to answer this question, we will need to make contact with the auditors or federal agents involved and gather several key pieces of information. What triggered the inquiry? What agencies are involved? Are any other providers being targeted? Is the inquiry civil or criminal in nature? The answers to these (and other questions) will usually point to allegations such as:
- – Overcharging for medical services, procedures, supplies, medications, or equipment (including “upcoding,” or submitting an incorrect billing code)
- – Unbundling related services or procedures in order to bill them separately at higher individual rates
- – Billing for services not provided, procedures not performed, or medications not prescribed (referred to as “phantom billing”)
- – Billing for services, procedures, or medications that do not meet the applicable standard for medical necessity
- – Falsifying patient records, including creating “ghost patients” to bill Medicare, Medicaid, Tricare, or the VA
- – Prescribing opioid pain medications without a valid prescription, or refilling an opioid prescription without conducting a re-examination
- – Improperly billing for telemedicine services (including billing for fees that are used to pay for referrals)
- – Offering, soliciting, paying, or accepting a referral fee (or other “remuneration”) under circumstances that do not qualify for safe harbor protection under the Anti-Kickback Statute
- – Paying or accepting unlawful referral fees for designated health services in violation of the Stark Law
- – Participating in a “conspiracy” to improperly bill a federal health care benefit program or divert prescription medications
However, while these are all common allegations, our experience has shown that federal authorities’ allegations are often misguided. By uncovering the true facts at hand and demonstrating that our clients are not guilty of the offenses for which they are being targeted, we have been able to resolve the majority of our clients’ audits and investigations without civil or criminal charges being filed.
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What Should You Do if You are Facing a Health Care Fraud Audit or Investigation in Guam?
If you are facing a federal health care fraud audit or investigation in relation to your medical practice or business operations in Guam, what should you do?
1. Seek Legal Counsel
If federal authorities are looking into your health care practice or medical business, you need a defense team that is capable of going toe-to-toe.
2. Don’t Keep Making Mistakes
If you (or any of your personnel) have made mistakes in the past, take remedial action promptly and ensure that you are not continuing to create more exposure.
3. Intervene in the Inquiry
Intervening in the audit or investigation will disrupt the process and allow you to gather the information you need to begin making informed decisions.
4. Build a Comprehensive Defense Strategy
You need to build and execute a defense strategy that is custom-tailored to the facts of your case and the nature and scope of the audit or investigation.
5. Focus on Securing a Pre-Charge Resolution
If at all possible, you want to resolve the inquiry without federal charges being filed. This will allow you to get back to business as usual as quickly as possible.
Speak with a Federal Health Care Fraud Defense Lawyer at Oberheiden P.C.
If you need federal heath care fraud defense counsel for an audit or investigation in Guam, contact Oberheiden, P.C. for a free and confidential case assessment. Our attorneys are available 24/7, so call 214-692-2171 or inquire online now.