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Healthcare Fraud Defense
Federal Attorneys Who Have Proven How to Defend Healthcare Fraud
Table of Contents
- Our Federal Defense Lawyers Represent Clients in Federal Healthcare Fraud Cases Nationwide
- Defending Healthcare Fraud: Choosing the Right Lawyer
- Cases We Handle
- Proven Results at All Stages of Federal Healthcare Fraud Prosecution
- Potential Consequences of a Federal Healthcare Fraud Audit or Investigation
- Speak with a Federal Healthcare Fraud Defense Lawyer at Oberheiden, P.C.
Audits & Investigations | Whistleblower Defense Strategies | Grand Jury Subpoenas & CIDs | FBI, HHS, OIG Investigations | Search Warrant Defense | Indictments | Criminal Defense & Trials | Corporate Compliance | Internal Investigations
Successfully Protected Healthcare Clients in 45+ States | 888-680-1745
Are you being punished for your success? You have worked very hard to build your business. You have contributed to your community, and you have helped to improve quality patient care. You never had criminal intent. Your employees and vendors have a job because of you. You pay high taxes so that everyone else can benefit. And now comes the government and threatens to jeopardize everything you have accomplished? Isn’t it true that the government really wants to punish you for being more successful than others? Well, we think so. That’s why we have put together the A-Team of Federal Defense for you.
- We Don’t Surrender, We Fix.
- Top Trial Team: No Junior Lawyers, No Paralegals
- Former FBI, Former DOJ Staff, Former U.S. Attorney
- 95% Success Rate: 45 States (1,000+ Cases)
Call Dr. Nick Oberheiden If You Had No Intent to Do Anything Wrong | 888-680-1745
Are you seeking a life saver? Imagine you have a heart attack. Would you call a dentist or a cardiologist? Probably a cardiologist, someone that has the specific background and the experience to fix the problem. Let’s be honest. A federal investigation is like a heart attack. Everything is on the line. If you or your practice are accused of healthcare fraud, you simply cannot afford to experiment. You need a cardiologist, a life-saver, to make sure that your business, your good name, and your freedom are protected.
You are at the right firm. Meet Attorney Dr. Nick Oberheiden. Nick has represented clients all over the country and demonstrated that healthcare fraud allegations are fixable. In fact, Nick has avoided civil liabilities and criminal charges in many hundreds of healthcare audits and FBI/OIG investigations, whistleblower cases, grand jury and CID proceedings, FBI interview requests, and even search warrants. No stranger to the court room, Nick and his team have dismissed indictments, obtained acquittals, and secured probation even in multi-million-dollar fraud cases. This is what clients have said about Nick publicly.
- “Brilliant Strategy”
- “A True Life Saver”
The best strategy and personal experience will determine your outcome. To see how personal our service is, just text or call Dr. Oberheiden. Get a free and confidential consultation from Nick directly, including on weekends.
Central Intake Contact for Dr. Nick Oberheiden | 888-680-1745
How We Are Different
There truly is no firm like Oberheiden P.C. What makes us different compared to any firm you may find online is the experience of our team and the proven results. Some lawyers will tell you that they can help you when in fact they might experiment with your freedom; other lawyers may understand healthcare laws, but they have never argued a case in court or made a compelling defense presentation in a room filled with FBI agents and federal prosecutors. Well, that’s what WE do every day: WE don’t experiment, WE don’t surrender. We fight, we fix, we resolve, we litigate healthcare fraud accusations.
- Covering Los Angeles, Miami, New York, Washington D.C., Houston, Dallas, and many more cities with local presence of experienced partner-level federal defense lawyers
- Former FBI Agents (also OIG, IRS, DEA, DOJ Special Agents)
- Former High-Ranking Federal Prosecutors
Find out for yourself. Get the relief that allows you to focus on your business while we take care of your case. Call us today. We are confident that 10 minutes with us will save you hours spent with lawyers that don’t even understand your industry, billing/coding, or where you first need to explain healthcare laws. Don’t waste your time. When you call Dr. Nick Oberheiden and his team, you will see why so many clients before you have trusted us when their financials, their good name, and their freedom was under attack.
What is Healthcare Fraud?
The scheme to defraud a healthcare program normally involves false or fraudulent representations designed to access something of value— usually money. The intent of the accused is almost always the central issue at any healthcare fraud trial. Many times errors in billing and coding make up a large part of the government’s case against a defendant. That being said, the mere fact that there are errors in bills and coding submitted does not necessarily mean that a defendant had the requisite intent to defraud a health insurance program.
Burden of Proof
When an individual is accused of healthcare fraud, the government has to prove that the defendant engaged in a scheme to steal from a healthcare program, such as Medicare, DOL, Medicaid, Tricare, another government insurance program or a private insurance program.
Common Examples
As seen, healthcare fraud is a generic term that encompasses a variety of conduct designed to illegally obtain a financial benefit of a provider to the detriment of the state or federal government. The following list is not exclusive, but it summarizes some of the most common healthcare fraud examples.
Kickbacks
The federal Anti-Kickback Statute is a criminal statute that prohibits persons or entities from knowingly
and willfully soliciting, receiving, offering, or paying remuneration for referrals for goods or
services payable to a government healthcare program, such as Medicare, Medicaid, and Tricare. This
statute is designed to prevent fraud and abuse. Kickbacks may include referral fees, finder’s fees,
bonuses, discounted leases, research grants, excessive compensation, and travel or entertainment.
Up-Coding Services
Billing of government and private insurance programs utilize numerical codes that identify the specific
procedure or service being performed. For every necessary procedure, government healthcare programs
assign a dollar amount it will pay. Up-coding occurs when a healthcare provider submits claims for
healthcare services that represent a more serious and/or more expensive procedure than what was
actually performed. Up-coding is a form of healthcare fraud and may be a violation of the False Claims
Act.
Services Not Rendered
Billing for services not rendered is a form of healthcare fraud that consists of submitting claims for
healthcare services that were never rendered.
Ghost Patients
Ghost patients are patients who either do not exist or who never received the service or item billed for
in the claim. Submitting claims for healthcare services of ghost patients are a form of healthcare
fraud.
Inflating Cost Reports
Medicare reimburses hospitals and healthcare institutions for certain costs for the treatment of
particular patients. These hospitals and healthcare institutions are required to file Cost Reports with
Medicare. One common type of healthcare fraud has been for hospitals or healthcare institutions to
inflate the costs on their Medicare Cost Reports, or to otherwise falsify information on these cost
reports to maximize Medicare reimbursement. Cost report fraud scenarios may include falsely inflating
costs related to patient care; seeking reimbursement for costs that are not related to patient care;
seeking reimbursement for costs for non-Medicare patients; and improperly manipulating statistics.
Medicare Part D Fraud
In 2003, Congress passed the Medicare Prescription Drug, Improvement, and Modernization Act, which added
“Part D” to the Medicare Program. The Part D program consists of prescription drug coverage and
prescription drug insurance premiums. Since its enactment, it is expected that the Part D program will
be the target of substantial fraud in the coming years. Forms of Medicare Part D Fraud include claims of
duplicate billing; overcharging; enrollment fraud; red-lining; and improper rebates from pharmaceutical
manufacturers and wholesalers.
Lack of Medical Necessity
In order to qualify for payment by government healthcare programs, healthcare services must be
medically necessary. healthcare providers are required by law to document the medical necessity of the
treatment or services for which they are seeking reimbursement. Submitting claims for services,
treatments, diagnostic tests, and medical devices that are not medically necessary is a common type of
healthcare fraud.
Improper Financial Interest
Federal and state laws and regulations prevent physicians and other healthcare providers from having a
direct or indirect financial interest in certain services provided to their patients. An example of this
is the federal Stark Law, 42 U.S.C. § 1395nn and § 1396b. The Stark Law prohibits a physician from
making a referral for certain designated health services to an entity in which the physician has an
ownership or investment interest or with which he or she has a compensation arrangement. In addition,
the Stark law covers investments and compensation paid to any member of the physician’s immediate
family. Violations of the Stark Law or another federal can also result in a violation of the False
Claims Act.
Bundling & Unbundling
A common type of healthcare fraud has been to “unbundle” procedures or tests and bill each one
separately, which pursuant to Medicare and Medicaid guidelines are to be billed together. Medicare and
Medicaid often will have lower reimbursement rates for groups of procedures commonly performed together.
And, unbundling billing codes illegally increases a provider’s profits, resulting in greater
reimbursement from Medicare and Medicaid.
False Certification
Physicians, hospitals and other healthcare providers are required to provide certain certifications when
submitting bills to government healthcare programs, such as Medicare, Medicaid, and Tricare. These
certifications include medical necessity, actual performance, and regulatory compliance. In addition,
healthcare providers that provide goods or services to government healthcare programs must satisfy all
contractual obligations with the government. Falsifying such certifications in order to get a health
care claim paid or to obtain additional business is a form of healthcare fraud and may also be a
violation of the False Claims Act.
Penalties
The goal we have when representing clients accused of healthcare fraud is to avoid criminal investigations. Oftentimes, an experienced healthcare fraud defense lawyer, such as one of our former federal prosecutors, is able to channel a healthcare fraud case onto a civil path so that a provider’s license and freedom remain untouched and intact.
How Our Experienced Healthcare Fraud Defense Attorneys Have Resolved Healthcare Fraud Cases
Most healthcare fraud cases are based on the theory that a medical provider or a healthcare business (lab, pharmacy, hospital, home health agency) submitted fraudulent billing claims to Medicare, Medicaid, Tricare, or a commercial insurance company. Because billing mistakes are not uncommon in an industry known for its regulatory complexity, for the government to be involved, the alleged fraud must be widespread, systematic, and financially significant. In this context, billing errors are financially significant if the received reimbursement exceeds tens or even hundreds of thousands of dollars. “Fraud” is a fairly undefined term and in most cases the government will allege that a healthcare service lacked medical necessity, was outside the accepted standards of care (e.g. excessive testing), was billed too high, or was billed for but not provided.
Oberheiden P.C. has proven that each of these scenarios is fixable. The sooner we get involved, the easier it is to resolve the matter. | 888-680-1745
You will know that you are under investigation if you or your business receives a healthcare audit request, a CID (Civil Investigative Demand), a subpoena from the Department of Health and Human Services (HHS) Office of Inspector General (OIG), a Grand Jury Subpoena from the Department of Justice (DOJ), or, if the case is already advanced, if your business experiences a federal search warrant or an indictment. An experienced attorney will understand the nuances of each of these scenarios and tailor a specific defense strategy.
Federal Healthcare Fraud (18 U.S.C. 1347)
- United States v. Client: Client was indicted for Medicare Fraud. The damage amount was $ 7m. Nick obtained probation for his client.
- United States v. Client: Client was indicted for Medicare Fraud. The damage amount was $ 3m. Nick obtained probation for his client.
- United States v. Client: Client was indicted for Medicaid Fraud. The damage amount exceeded $ 1m. Nick obtained probation for his client.
- See 100+ more examples of Oberheiden P.C. healthcare fraud cases here.
Anti-Kickback Law (42 U.S.C. 1320a-7b)
One of the most common allegations in healthcare fraud investigations are so-called kickbacks. Unlike most other industries, healthcare laws prohibit certain types of referral incentives to protect the integrity and independence of a physician’s professional judgment. Even though virtually anything of value may qualify as a kickback (not just straight payments, but also indirectly through physician distributions in MSOs or medical directorship agreements etc.), most kickback cases are surprisingly defendable. A successful client defense requires two attorney skillsets: a superb healthcare law understanding as well as the ability to lead tough negotiations through compelling arguments. The following are just a few representative examples of how Oberheiden P.C. has successfully defended civil and criminal kickback cases across the entire country.
- United States v. Client: Federal kickback investigation against spine surgeon. No civil or criminal liability.
- United States v. Client: FBI investigation against Client. No civil or criminal liability.
- United States v. Client: Dismissed.
- See 100+ more Anti-Kickback examples of Oberheiden P.C. cases here.
False Claims Act (18 U.S.C. 287)
Most False Claims Act cases originate as whistleblower cases. That is, someone, often a former employee or a competitor, reports alleged fraud to the government by filing a lawsuit in an effort to later collect a reward. Targets of these whistleblower cases often find out about the existence of an investigation when they receive a Civil Investigative Demand (CID) or another form of a government subpoena (e.g. OIG subpoena) requesting documents and corporate information. The absolute priority in all False Claims Act defense cases is to make sure that the investigation does not turn into a criminal case—that is something Oberheiden P.C. has accomplished in every single whistleblower case. By the same token, Oberheiden P.C. is an asset protection specialist and protected the financial stability of its clients by dismissing or favorably settling False Claims Act cases (e.g. in Los Angeles, in Florida, in Houston, in Philadelphia, in Dallas, in Portland, in Ohio etc.).
- United States v. Client: OIG investigation against laboratory. Our defense resulted in no civil and no criminal liability for our client. Case dismissed, no liability.
- United States v. Client: OIG/FBI kickback investigation against marketing company. Our defense resulted in no civil and no criminal liability for our client. Case dismissed, no liability.
- United States v. Client: FCA investigation against physician practice. Our defense resulted in no civil and no criminal liability for our client. Case dismissed, no liability.
- See 100+ more False Claims Act defense examples of Oberheiden P.C. here.
Aggravated Identity Theft
Aggravated identity theft is a good illustration to understand how important it is to be represented by trusted, experienced healthcare fraud defense attorneys. Recently, the Justice Department started to add aggravated identity theft to healthcare fraud indictments. Each count contains a mandatory two-year imprisonment. That means, probation is not an option. Oberheiden P.C. saw this trend quickly, and has successfully argued why aggravated identity theft is simply not applicable in the case—and saved clients from years of unnecessary prison time. Again, don’t gamble with your future. Call Oberheiden P.C. today.
- United States v. Client: We avoided aggravated identity theft charges for our client and were able to stop the investigation against our client in its entirety. No charges.
- United States v. Client: OIG/FBI kickback investigation against marketing company. Our defense resulted in no civil and no criminal liability for our client. Case dismissed.
- United States v. Client: FCA investigation against physician practice. Our defense resulted in no civil and no criminal liability for our client. Case dismissed.
- See 100+ more examples of how Oberheiden P.C. defended federal felonies here.
Federal Conspiracy (18 U.S.C. 1349)
Many federal healthcare fraud cases are brought as a conspiracy. The government essentially claims that multiple people have contributed something to the overall success of a fraud scheme. Let’s take the example of a marketer (M), a doctor (D), and a pharmacy (P). If a M unlawfully incentivizes D to send referrals to the pharmacy (“kickbacks”), then all three individuals may be charged by way of a conspiracy: the marketer for bribing, the doctor for accepting the bribe, and the pharmacy for billing claims that were based on a kickback. Oberheiden P.C. knows how to break that chain. We have successfully defended against hundreds of conspiracy charges, call us now to see how we did it!
- United States v. Client: We avoided aggravated identity theft charges for our client and were able to stop the investigation against our client in its entirety. No charges.
- United States v. Client: OIG/FBI kickback investigation against marketing company. Our defense resulted in no civil and no criminal liability for our client. Case dismissed.
- United States v. Client: FCA investigation against physician practice. Our defense resulted in no civil and no criminal liability for our client. Case dismissed.
- See 100+ more examples of how Oberheiden P.C. avoided or defended federal conspiracy charges here.
Our Pledge to You
- No Associate or Junior Lawyer Will Work on Your Case
- You Will Speak
- You Will Benefit from Our Experience and Reputation
Our Federal Defense Lawyers Represent Clients in Federal Healthcare Fraud Cases Nationwide – Including all CMS, DEA, DOJ, and OIG Matters
Regardless of your role within the healthcare industry, facing federal fraud allegations is an extremely serious matter. If federal agents are targeting your business or practice based upon allegations of Medicare, Medicaid, Tricare, or Department of Labor (DOL) fraud, failing to find the best healthcare fraud defense could result in exposure to significant civil or criminal penalties.
Federal healthcare fraud allegations can take a variety of different forms, and federal prosecutors can pursue civil and criminal charges under a multitude of federal statutes. As a result, when facing a federal healthcare fraud investigation, a critical early step is to determine the scope and nature of the allegations against you. Are you being accused of overbilling Medicaid or Tricare? Are you being accused of using Medicare-reimbursed funds to pay “kickbacks” or referral fees? Are you being accused of improperly prescribing, dispensing, or billing for opioid medications? Until you know why you are being targeted, you simply have no way of asserting an effective defense.
At Oberheiden, P.C., a significant portion of our practice is devoted to defending clients in federal healthcare fraud matters. When you engage our federal defense team to represent you, our attorneys will work to quickly get to the bottom of the government’s investigation. To find out why you are being targeted and what penalties are on the table, call 888-519-4897 for a free and confidential case assessment from one of our senior healthcare fraud defense lawyers.
Defending Healthcare Fraud: Choosing the Right Lawyer
Healthcare fraud is a serious offense. Depending on the magnitude and the intent level of the wrongdoing, penalties range from civil monetary damages to imprisonment. More than ever before, the government is prosecuting healthcare fraud, and, for those that find themselves in the middle of a federal healthcare fraud the question becomes: which lawyer should I hire to defend me? This brief blog will explain how the complexity of healthcare laws and regulations and corresponding government investigations should discourage targets of a healthcare investigation from hiring just any lawyer.
While every lawyer offers a skillset for certain areas of laws, effective healthcare fraud defense demands more than just being a generalist. Three features should be immediately noticeable when you talk to an attorney to defend yourself against a potential or actual government investigation: (1) a profound understanding of healthcare law, (2) a proven experience with government investigations, and (3) an impeccable track record.
Healthcare Law Background
First and foremost, the attorney you engage must be profoundly familiar with all healthcare laws. Many healthcare fraud cases operate between fine lines of honest mistakes and criminal liability. Often, this fine line is the decisive factor. A potential client should ask the lawyer how many healthcare clients he or she has represented in the past in the area of the client’s needs. Advising a chiropractor to set up an LLC is different from providing a comprehensive regulatory analysis for a DNA testing facility or conducting an internal audit for a toxicology laboratory.
But don’t just stop at theoretical knowledge. While there are a great number of healthcare lawyers, very few of them are trained to negotiate with FBI agents and government lawyers, and even fewer lawyers have ever argued a case in court. In fact, most healthcare lawyers understand the theory of healthcare law, but lack the practical component of arguing a case at the U.S. Attorney’s Office or the Office of Inspector General.
Government Experience
Healthcare law and fraud and abuse investigations operate in a small circle of lawyers and government officials. Attorneys frequently run into the same FBI agents and work routinely with the same prosecutors and appear before the same judges. This experience may help the lawyer to better anticipate the government’s next step, and may ease settlement negotiations with the government. After all, if your lawyer kept his or her word in the last case, the prosecutor will remember and trust him or her in this case. People talk, and lawyers at the U.S. Attorney’s Office and healthcare fraud defense attorneys are no exception. Reputation and past interactions with the government can make a decisive difference, especially in areas like healthcare investigations where the line between mistake and criminal misconduct can be very thin at times.
Track Record
Finally, before hiring an attorney to represent you to maintain your freedom, you should find out what the lawyer’s track record is in cases similar to yours. Being a great general criminal defense lawyer is wonderful, when you are accused of assault or robbery. Instead, you should ask for the attorney’s track record in healthcare matters. What was the outcome in previously handled healthcare fraud cases? Was the lawyer able to avoid criminal charges? How many healthcare fraud cases were dismissed under your lawyer’s leadership?
Why Choose Oberheiden, P.C. for Federal Healthcare Fraud Defense
Our firm is comprised entirely of attorneys who are highly-experienced in federal civil and criminal matters, and many of our attorneys have well over a decade of experience in federal healthcare fraud defense. This includes founding attorney Dr. Nick Oberheiden, who is recognized nationwide for his results in civil and criminal healthcare fraud investigations, as well as several former senior prosecutors and trial attorneys with the U.S. Department of Justice (DOJ).
With centuries of combined experience in high-level federal matters, including more than 70 years of experience as DOJ prosecutors and trial lawyers, our attorneys have handled federal healthcare fraud cases involving all relevant federal agencies. This includes assisting in and defending against investigations and prosecutions conducted by the Department of Justice, Centers for Medicare and Medicaid Services (CMS), Drug Enforcement Administration (DEA), Office of Inspector General (OIG) of the Department of Health and Human Services (DHHS), and other agencies ranging from the Federal Bureau of Investigation (FBI) to the Internal Revenue Service (IRS). Our attorneys have been on both sides of cases involving all relevant statutes and sources of regulatory authority, and we have avoided charges and won trials in cases involving virtually all healthcare fraud allegations prosecuted under federal law.
If you or your business or practice is being targeted by federal authorities, this is the type of experience you need on your side. You need attorneys who can not only level the playing field, but who can tip the scales in your favor. With our attorneys’ vast federal defense experience and in-depth knowledge of the legal and medical principles involved in federal healthcare fraud investigations, we have become go-to defense counsel for healthcare providers and medical industry businesses across the country.
This is Why You Are in Good Hands
When you should choose Oberheiden, P.C. for your federal healthcare fraud matter:
- We will begin working on your defense immediately. With our attorneys’ experience representing healthcare providers and medical industry businesses across the country, we have cultivated a body of knowledge that allows us to get to work on our clients’ cases immediately. Unlike other firms, we do not need time to get up to speed on the legal and medical issues involved.
- We will work diligently to secure an efficient and discrete resolution. In today’s world, even unproven allegations can have devastating consequences for a business or practice. Our attorneys understand these types of concerns, and we will work to secure a discrete and favorable outcome as efficiently as possible.
- We will promptly assess your risk. By immediately intervening in the government’s investigation, we can quickly discern the allegations against you, including the volume of these allegations and whether they are civil or criminal in nature.
- We will be fully prepared if your case goes to trial. If your only option is to go to court, we will be fully prepared to represent you at trial when the time comes. Our attorneys have handled hundreds of civil and criminal trials in federal jurisdictions nationwide
- We will help you and your team make informed decisions. When facing a federal healthcare fraud investigation, there are several critical mistakes you need to avoid. Our attorneys will walk you through everything you need to know and train your staff so that you can effectively aid in your defense.
Put our highly experienced team on your side
Dr. Nick Oberheiden
Founder
Attorney-at-Law
John W. Sellers
Former Senior Trial Attorney
U.S. Department of Justice
Local Counsel
Joanne Fine DeLena
Former Assistant U.S. Attorney
Local Counsel
Joe Brown
Former U.S. Attorney & Former District Attorney
Local Trial & Defense Counsel
Amanda Marshall
Former U.S. Attorney
Local Counsel
Aaron L. Wiley
Former Federal Prosecutor
Local Counsel
Roger Bach
Former Special Agent (OIG)
Michael Koslow
Former Supervisory Special Agent (FBI)
Chris Quick
Former Special Agent (FBI & IRS-CI)
Kevin M. Sheridan
Former Special Agent (FBI)
Ray Yuen
Former Supervisory Special Agent (FBI)
Dennis A. Wichern
Former Special Agent-in-Charge (DEA)
More about Our Federal Healthcare Fraud Defense Practice
Cases We Handle
We represent individuals and businesses in civil and criminal healthcare fraud matters nationwide. This includes representing licensed professionals, practice and business owners, facility administrators, clinics, laboratories, hospitals, hospices, home health agencies, and other clients in audits, investigations, and prosecutions in all 50 states. With a significant portion of our practice devoted to federal healthcare fraud defense, we routinely represent clients facing allegations such as:
- Overbilling Medicare, Medicaid, Tricare, or the DOL
- Improperly prescribing, dispensing, or diverting opioid medications
- Billing for services not provided (so-called “phantom billing”)
- Improper practices related to physician certifications or patient election statements
- Billing for services that were not medically necessary
- Falsifying patient records or test results
- Double-billing federal benefit programs and/or a private health insurer
- Offering or accepting illegal kickbacks, bribes, or referral fees
- Billing and coding violations (including “upcoding” and “unbundling”)
- Attempt or conspiracy to commit healthcare fraud
Are you accused of a federal crime?
Don’t delay. Learn about your rights.
Call Dr. Nick Oberheiden now!
Available nights and weekends
Proven Results at All Stages of Federal Healthcare Fraud Prosecution
If you have been contacted by federal agents or auditors working with CMS, it is important that you seek the best healthcare fraud defense attorney promptly. While going to trial on federal charges is a very real possibility, it is also possible that you could resolve your case short of trial – and potentially without charges ever being filed. In fact, we have resolved the vast majority of our clients’ cases at the investigative stage; and, to date, we have avoided prosecution in every False Claims Act investigation we have handled.
1. Fee-For-Service Contractor Audits (MAC, RAC, ZPIC)
Fee-for-service contractors working with CMS audit Medicare-participating healthcare providers on a regular basis. Unfortunately, these auditors have a financial incentive to find violations, and they often lack the up-to-date and in-depth knowledge required in order to accurately assess providers’ compliance with the Medicare billing regulations. We regularly represent providers in audits and appeals involving Medicare Administrative Contractors (MACs), Recovery Audit Contractors (RACs), Zone Program Integrity Contractors (ZPICs) / ZPIC audit, and other CMS fee-for-service audit contractors.
2. Federal Investigations
Federal healthcare fraud investigations can be civil or criminal in nature, and they can involve agents from CMS, DEA, DOJ, FBI, IRS, OIG, and various other agencies and task forces. The majority of our federal heath care fraud defense practice involves representing clients at the investigative stage, and we have protected the majority of our clients against any civil or criminal liability.
3. Grand Jury Proceedings
If you have been served with a grand jury subpoena, you do not have any time to waste. Federal prosecutors are pursing criminal charges, and an indictment will put your case on the path toward trial. We have extensive experience representing clients in federal grand jury proceedings, from challenging subpoenas to providing advice and representation in the courthouse.
4. Pre-Trial Practice and Plea Deal Negotiations
Once an indictment or civil charges have been issued, there will still be a significant amount of time before your case goes to trial. While many firms use this time exclusively for trial preparation, we use it as an opportunity to continue to fight for a favorable pre-trial resolution. From having indictments dismissed to negotiating plea deals that protect our clients’ practices and keep them out of prison, we utilize a variety of aggressive pre-trial defense strategies to protect our clients from the possibility of a “guilty” verdict at trial.
5. Trials and Sentencing
At the federal level, trial on the merits and sentencing are separate proceedings. Each requires a different approach, and our attorneys have extensive experience on both sides of federal healthcare fraud trials. We can use this experience to protect you, whether that means convincing the jury that the government has not met its burden of proof or arguing for a sentence below what is called for under the Federal Sentencing Guidelines.
6. Appeals
In addition to handling civil and criminal healthcare fraud cases at the trial level, we also represent clients on appeal. Our defense team includes highly-experienced appellate attorneys who are licensed to practice before multiple U.S. Circuit Courts of Appeal.
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Your Healthcare Fraud Defense Team
Our Team
Experts & Consultants
Potential Consequences of a Federal Healthcare Fraud Audit or Investigation
The potential consequences of a federal healthcare fraud audit or investigation vary depending upon the type of fraud alleged and the number of violations of which you are being accused. In all cases, however, the consequences can be severe, and some practitioners and business owners will face business-threatening and life-altering consequences as a result of the government’s inquiry. Depending on the circumstances involved, the consequences of being targeted for healthcare fraud can include:
- Recoupments – Providers and businesses accused of overbilling Medicare, Medicaid, Tricare, or the DOL will be required to repay all overbilled amounts and may be subjected to pre-payment review going forward.
- Program Exclusion – Civil and criminal healthcare fraud violations can result in exclusion from Medicare, Medicaid, Tricare, and DOL program participation.
- Treble (Triple) Damages – In addition to recoupments, providers and businesses will also generally be required to pay treble damages, or three times the government’s actual losses.
- Licensing and/or Registration Consequences – Healthcare fraud offenses can result in loss of DEA registration and trigger disciplinary action by state licensing boards.
- Civil or Criminal Fines – Civil and criminal healthcare fraud offenses also carry steep fines, with fines often applying on a “per-claim” basis.
- Federal Imprisonment – In criminal healthcare fraud cases, practitioners and business owners can face the potential for years, or even decades, of federal imprisonment.
- Civil or Criminal Fines – Civil and criminal healthcare fraud offenses also carry steep fines, with fines often applying on a “per-claim” basis.
- Costs and Attorneys’ Fees – Providers and businesses found guilty of healthcare fraud may also be required to pay the government’s cost of prosecution.
