Health Care Fraud Defense for Dermatology Clinics
Federal Defense Attorneys for Dermatology Clinics Facing Health Care Fraud Allegations
Dermatology clinics that bill federal healthcare programs (i.e., Medicare and Medicaid) are subject to stringent billing rules and regulations. They are also subject to other statutory requirements enforced by the U.S. Department of Health and Human Services’ Office of Inspector General (HHS OIG) and the U.S. Department of Justice (DOJ).
Like all program-participating health care providers, dermatology clinics that improperly bill the federal government or commit other violations can face serious consequences. While these consequences include civil penalties in most cases, the DOJ will also pursue criminal charges when warranted.
We Defend Dermatology Clinics in All Types of Health Care Fraud Investigations
At Oberheiden P.C., our attorneys represent dermatology clinics that are facing scrutiny from HHS OIG, DOJ, and other federal authorities. We also represent dermatology clinic executives and personnel who are facing civil and criminal investigations. These are high-risk matters that require experienced legal representation. Our attorneys have experience defending a wide range of healthcare providers and medical professionals against allegations including:
Fraudulent Billing Practices
Fraudulent billing practices under federal healthcare benefit programs can expose dermatology clinics and other medical providers to steep penalties. While most billing fraud investigations under the False Claims Act are civil in nature, Medicare and Medicaid billing fraud allegations can also lead to criminal charges in some cases.
Some examples of common allegations in federal investigations targeting dermatology clinics’ program billing practices include:
- Billing for dermatology services rendered by someone who lacks the required medical license
- Billing for dermatology services that lack medical necessity
- Billing for a more expensive service than the dermatology service actually provided
- Double-billing, upcoding, unbundling, and other fraudulent billing practices
- Falsifying patient or billing records in order to improperly bill Medicare or Medicaid
The False Claims Act is a federal law that prohibits healthcare providers from submitting “false or fraudulent” claims for reimbursement under the federal health care system. Billing fraud investigations routinely involve allegations under the False Claims Act, and dermatology clinics that are not prepared to affirmatively demonstrate compliance can face penalties that they could—and should—have avoided. Our attorneys rely on detailed knowledge of the False Claims Act and federal agencies’ investigative tactics to protect clients accused of billing fraud by all means available.
Illegal Kickbacks and Referral Fees
Payment and receipt of illegal kickbacks and referral fees in connection with dermatology clinics’ operations can also lead to civil or criminal charges. This includes illegal transactions involving referring physicians, pharmaceutical companies, and other individuals and entities.
Federal prosecutors rely on two primary statutes when pursuing allegations related to illegal kickbacks and referral fees: the Anti-Kickback Statute and the Stark Law. While these laws are similar in some respects, they impose different prohibitions and are subject to different safe harbors, so it is critical to work with a team of knowledgeable attorneys who can help you execute a sound defense strategy based on the specific circumstances at hand.
Durable Medical Equipment (DME) Fraud
Dermatology clinics can also face investigations targeting their purchase, use, and claimed use of durable medical equipment (DME). This includes investigations targeting allegedly fraudulent billings and improper referral fees, among other issues. While dermatology clinics can bill Medicare and Medicaid for their use and resale of medical devices when these programs’ billing rules allow, dermatology clinics can also commit healthcare fraud when they bill for DME and related health services inappropriately.
Prescription Fraud
Prescription fraud is a common focus of federal health care fraud investigations targeting dermatology clinics and other healthcare providers as well. In these cases, federal agents with the Drug Enforcement Administration’s (DEA) Diversion Control Division often work alongside their federal law enforcement counterparts to substantiate charges not only under the False Claims Act, Anti-Kickback Statute, and Stark Law, but under the Controlled Substances Act (CSA), Drug Supply Chain Security Act (DSCSA), and other federal drug laws as well.
We Also Defend Dermatology Clinics, Executives, and Personnel Facing Federal Healthcare Fraud Charges
Along with defending clients during federal healthcare fraud investigations, we also defend clients that are already facing federal charges. If you or your clinic is facing prosecution for any healthcare-related federal offense, we can help, but it is important that you contact us immediately.
Understanding the Risks of Facing Healthcare Fraud Allegations
Regardless of the specific allegations at issue, facing scrutiny from HHS OIG, DOJ, DEA, or any other federal authority can present substantial risks. Depending on the circumstances involved, facing fraud allegations related to a clinic’s dermatology healthcare services can lead to penalties including:
- Recoupments and treble damages
- Civil monetary penalties (CMP)
- Criminal fines
- Loss of federal healthcare program eligibility
- Federal imprisonment
While dermatology clinic executives and personnel won’t be at risk of facing criminal prosecution in most cases, this is a very real possibility—and it is not a possibility you can ignore. If you have received a target letter or federal agents have shown up at your clinic with a search warrant, you could already be the target of a criminal case, and this is a scenario that demands immediate intervention.
How We Defend Dermatology Clinics Against Recoupments and Penalties for Health Care Fraud
When we serve as healthcare fraud defense counsel for dermatology clinics and other clients, we take a comprehensive approach focused on protecting our clients to the fullest extent possible. We also focus on keeping our clients’ cases as discrete as possible and targeting efficient resolutions that allow our clients to get back to focusing on patient care.
Recognizing that every case is unique, our approach to defending dermatology clinics and other clients during federal health care fraud investigations generally involves:
1. Prompt Intervention
Once you engage our firm, we will promptly intervene in the government’s investigation. We will work to quickly discern the investigation’s scope, and we will work to delay any impending next steps as we build your defense.
2. Privileged Risk Assessment
To build your defense, we will begin by conducting a comprehensive internal risk assessment under the protection of the attorney-client privilege. Once we know what, if anything, federal authorities are likely to find, then we can formulate a targeted defense strategy.
3. Defense Strategy Formulation
Our attorneys rely on their extensive experience, including prior experience as federal healthcare fraud prosecutors at the DOJ, to develop custom-tailored defense strategies for all of our clients. We take a comprehensive and cohesive approach focused on maximum risk mitigation.
4. Defense Strategy Execution
Once we have a strategy in place, we execute. All of our attorneys work quickly to execute our clients’ defense strategies with a focus on resolving the government’s inquiry before it leads to any unnecessary consequences.
5. Client Advice and Guidance
As we work to favorably resolve the government’s investigation, we will also remain in close contact with you throughout the process. Our attorneys will provide the advice and guidance you need to make sound decisions every step of the way.
FAQs: Medicare and Medicaid Fraud Defense for Dermatology Clinics
Federal authorities target dermatology clinics and other healthcare providers with fraud allegations for a variety of reasons. Billing irregularities, whistleblower complaints, and referrals from Medicare and Medicaid auditors are all common triggers, but healthcare fraud investigations can have other triggers as well. Once we intervene in the government’s investigation, we can seek to find out what triggered the inquiry.
What Are the Possible Outcomes of a Healthcare Fraud Investigation?
The potential outcomes of a healthcare fraud investigation range from concluding the investigation without further action to facing civil penalties or criminal prosecution. At Oberheiden P.C., we focus on favorably resolving our clients’ healthcare fraud investigations without formal legal action whenever possible.
What Types of Evidence Can Federal Prosecutors Use to Prove Healthcare Fraud?
From billing records to sworn testimony, federal prosecutors can use a variety of types of evidence to prove healthcare fraud. During our attorney-client privileged risk assessment, we will seek to identify any evidence that federal agents may be able to obtain during the investigative process.
How Can Health Care Providers Avoid Penalties Resulting from a Billing Fraud Investigation?
Avoiding penalties during a healthcare billing fraud investigation requires a proactive and strategic defense. While there are no guarantees, engaging experienced defense counsel promptly can help to significantly mitigate the risks involved in many cases.
When Should Dermatology Clinics Engage Legal Counsel for Healthcare Fraud Defense?
Dermatology clinics should engage legal counsel at the first sign of a federal healthcare fraud investigation. If your clinic is facing scrutiny from federal authorities, we strongly encourage you to contact us right away.
Contact Us About Your Dermatology Clinic’s Federal Health Care Fraud Case Today
If your dermatology clinic is facing scrutiny from federal authorities, we can help you fight to avoid unnecessary consequences. To speak with a senior federal healthcare fraud defense lawyer at Oberheiden P.C. in confidence as soon as possible, call us at 888-6801745 or tell us how we can reach you online now.
Further Information About Our Healthcare Fraud Defense Services
Disclaimer:
The content on this site is informational only and describes mere allegations. The content does not suggest evidence, proof, or guaranteed liability. The merits of each case depend on specific facts. Prior results do not guarantee similar outcomes in future cases. For more details, please see our FTC and general disclaimers. Oberheiden Law is the law firm in charge.
