Hawaii Health Care Fraud Defense Lawyers
Our federal health care fraud defense team provides skilled legal representation for licensed providers, executives, administrators, and business owners in Hawaii. If you are facing an audit or investigation, the attorneys at Oberheiden, P.C. can help you avoid drastic consequences.
Why are auditors or federal investigators scrutinizing your practice’s billing records? What is health care fraud? Could you really be guilty? If so, what do you need to do in order to avoid severe civil or criminal penalties? With increasing frequency, health care providers in Hawaii are being forced to grapple with these difficult questions.
Combatting fraud, waste, and abuse in the federal health care benefit systems is a top priority for senior officials at the Centers for Medicare and Medicaid Services (CMS), the U.S. Department of Defense (DOD), the U.S. Department of Justice (DOJ), the U.S. Department of Health and Human Services (DHHS), the U.S. Department of Veterans Affairs (VA), and other federal agencies. Fighting the nation’s opioid epidemic is a top federal priority as well, and the DOJ and other agencies have chosen to tackle the problem by targeting health care providers that prescribe and dispense opioid medications. These factors combine to create extreme risks for health care providers, and those that are targeted for prosecution can face loss of program eligibility, recoupments, fines, treble damages, and even federal imprisonment.
Two Months, Two High-Profile Cases of Criminal Health Care fraud in Hawaii
Consider this: In May 2019, a physical therapist in Oahu was sentenced to 42 months in prison, $3.7 million in restitution, and a $3.7 million forfeiture for submitting false claims to Medicare, Medicaid, and Tricare over a six-year period. According to the DOJ, his unlawful conduct included misrepresenting that he treated patients who were in fact seen by unlicensed staff members and “rounding up” the duration of patient visits to the maximum time allowed. At the sentencing stage of the doctor’s case, the judge emphasized the importance of imposing a substantial sentence in order to, “deter others from committing similar crimes.”
Two months later, a doctor in Maui pleaded guilty to two counts of health care fraud and one count of prescription drug fraud following a Drug Enforcement Administration (DEA) investigation. According to the DOJ, the doctor was charged with billing Medicare and Medicaid for prescriptions that he wrote for his patients but then subsequently delivered to other individuals. He was also charged with keeping prescribed medications in order to “creat[e] a stockpile from which he could provide ‘trial samples’ to patients without writing them a prescription.”
These are just two of the most high-profile cases from the last year. Many more providers and medical businesses in Hawaii are facing audits and investigations, and those that are not prepared to defend themselves are facing severe penalties.
When is it Time to Be Concerned?
Program auditors and federal agents are working around the clock to fight health care fraud and prosecute health care providers who intentionally violate the law. So, as a licensed provider, executives, administrators, or business owner in Hawaii, when is it time for you to be concerned?
- You have Been Contacted by a MAC, RAC, UPIC, or ZPIC – Medicare administrative contractors (MACs), recovery audit contractors (RACs), unified program integrity contractors (UPICs), and zone program integrity contractors (ZPICs) all work with CMS to identify fraudulent overbillings and recoup overpayments on behalf of the federal government. If you have been contacted by one of these contractors, your practice or business is being audited, and you should engage federal health care fraud defense counsel promptly.
- You have Been Contacted by Federal Agents Who Want to Conduct “Interviews” – While federal authorities use a number of formal mechanisms to collect evidence during health care fraud investigations (more on this below), they also frequently seek to informally “interview” practitioners and other individuals. These inquiries may seem non-threatening, but federal agents do not visit health care providers’ homes and businesses for no reason. If federal agents have shown up at your door, it is important that you speak with a lawyer right away.
- You have Received a Target Letter or Civil Investigative Demand (CID) – Target letters and civil investigative demands (CIDs) are investigative tools that allow federal authorities to collect an extraordinary amount of information. The grounds for legally challenging the government’s investigative efforts at this stage are extremely limited, and targets must be extremely careful to avoid unnecessarily disclosing information that could expose them to federal prosecution.
- You have Received a Federal Search Warrant or Subpoena – If you have been served with a federal search warrant or subpoena, this means that federal authorities have strong reason to believe that you have committed (or were involved in the commission of) a federal health care fraud offense. You are entitled to legal representation during the government’s search and when responding to the subpoena, and it is strongly in your best interests to engage highly-experienced federal defense counsel promptly.
- You are Aware of Intentional or Unintentional Misconduct – If you have not yet been contacted by auditors or federal agents but you are aware of intentional or unintentional misconduct (such as overbilling Medicare or improperly prescribing opioid medications), this too is a situation in which experienced legal representation is required. Not only must you come into compliance as quickly as possible, but you may also have an obligation to self-report the violation to the federal government in order to mitigate any potential penalties.
In each of these scenarios, your first step should be to speak with an experienced federal health care fraud defense attorney. When dealing with auditors or federal agents, it is absolutely essential to avoid mistakes that could increase your risk of prosecution. At Oberheiden, P.C., we bring centuries of experience to representing health care providers in Hawaii, and we can begin working to protect you immediately.
What are Some of the Most-Common Examples of Health Care Fraud?
Health care fraud can take many different forms; and, during audits and investigations, providers must be careful to avoid unnecessarily producing any records or saying anything that could substantiate civil or criminal allegations. For example, while many providers who have committed unintentional billing errors assume that it is in their best interests to be fully transparent and cooperate in the government’s inquiry, the reality is that these efforts can actually increase providers’ risk of penalization for civil health care fraud.
All of the following are common examples of allegations against doctors, pharmacists, clinics, testing laboratories, telemedicine companies, durable medical equipment (DME) companies, and others in health care fraud audits and investigations:
- Intentionally and unintentionally overbilling Medicare, Medicare, Tricare, and the VA
- Billing for services not provided (“phantom billing”) or for non-existent patients (“ghost patients”)
- Billing for services that do not quality as “medically necessary” under the applicable program regulations
- Upcoding, unbundling, double-billing, and other billing and coding violations
- Falsifying certifications, test results, and other patient records
- Improperly prescribing or dispensing opioid medications
- Offering, soliciting, paying, and accepting unlawful referral fees, rebates, or kickbacks
- Attempting to commit health care fraud
- Participating in a conspiracy to defraud the federal government or unlawfully distribute opioid medications
What are the Potential Penalties for Federal Health Care Fraud in Hawaii?
The penalties for health care fraud under the False Claims Act, the Anti-Kickback Statute, the Stark Law, and other federal statutes are severe. In cases involving civil health care fraud allegations, penalties can include:
- Civil fines
- Treble (triple) damages
- Attorneys’ fees
- Non-payment of pending and future claims
- Loss of Medicare, Medicaid, Tricare, and VA eligibility
When charged criminally under the False Claims Act or the Anti-Kickback Statute, health care providers can face criminal fines and federal imprisonment. In criminal cases, DOJ prosecutors may bring charges for mail fraud, wire fraud, money laundering, and other crimes as well, and these charges can add up to create exposure to millions of dollars in financial penalties and decades behind bars.
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Why Do Hawaii Health Care Providers and Business Owners Choose Oberheiden, P.C.?
1. Our Team
Our health care fraud defense team is comprised entirely of senior attorneys and senior former federal agents. When you choose Oberheiden, P.C., you will not have paralegals and junior associates working on your defense.
2. Our Experience
When facing a federal investigation, who better to have on your side than former federal agents and former DOJ prosecutors? Together, our attorneys have over 70 years of federal prosecutorial experience and centuries of combined experience on both sides of federal health care fraud matters.
3. Our Results
We have resolved the majority of our clients’ cases without civil or criminal charges being filed, and to date not a single one of our clients has been penalized under the False Claims Act. We are committed to achieving favorable results for our clients, and we are prepared to do whatever it takes to protect you.
Speak with One of Our Senior Health Care Fraud Defense Lawyers in Confidence
If you are facing a federal health care fraud audit or investigation in Hawaii, we encourage you to contact us promptly to discuss how we can help. To speak with a member of our defense team in confidence, call 214-692-2171 or request a free case assessment online now.