DOL Fraud Explained by Federal Defense Attorneys
As in Medicare Fraud, Department of Labor (DOL) Medical Fraud assumes that with illegal intent, a healthcare provider attempted to, or did, defraud the federal government, or assisted others to commit fraud.
Services Not Rendered
A common accusation in DOL fraud is that a particular service, device or pharmaceutical product billed to the government was never provided to the patient. In extreme cases, submission of claims for patients who never existed could occur.
Up-Coding and Bundling
Many of DOL fraud cases involve upcoding and bundling healthcare services. When upcoding, a provider bills for a diagnosis or service more serious and expensive than the actual service provided. Bundling combines services under group rates in order to request a higher group pay rate. Unbundling splits a service to receive a higher pay rate by billing items separately.
Under federal law, remunerations, offers, payments, solicitations, or receipt of remuneration to entice, compensate, or reward a patient referral payable by a government healthcare program is illegal. Courts consider even the smallest attempt at bribing referrals a violation of the federal Anti-Kickback Statute, 42 U.S.C. § 1328-7b(b) and the Federal False Claims Act.
Who Are Targets?
The reason a DOL provider may become a target of an investigation varies from case to case. Most audits by the Department of Labor are initiated due to one of the following events:
- Complaint by Former Employee
- Complaint by Former Patient
- Excessive or Suspicious Billing Practice
- Connection to Another DOL Investigation
What Are the Penalties?
DOL fraud and general healthcare fraud constitute serious federal felonies that can be charged in one of two ways.
The government can request recoupment, often under the provisions of the False Claims Act. The difference between what was charged and paid to the provider and what should have been charged and paid is sought. In addition to paying the difference, the government typically imposes a civil fine based on a percentage of the total damage caused by the billing error.
Healthcare and DOL program fraud can also be charged as felonies. Prosecutors attempt to charge the healthcare company’s responsible owners and staff with healthcare fraud under 18 U.S.C. § 1347. Each count under 18 U.S.C. § 1347 carries a maximum sentence of 10 years imprisonment.
Is My Case Civil or Criminal?
In any DOL inquiry, determining if the case is civil or criminal is one of the most important questions. Investigations can go either direction and government lawyers are divided into civil and criminal prosecutors.
The best way to find out what prompted an inquiry is to establish a dialogue with the officials in charge. Experienced defense lawyers will understand why the government is interested in your practice. Knowing the context and objectives of the inquiry allow attorneys to develop the proper defense.
The experienced DOL fraud defense lawyers of Oberheiden, P.C., some former prosecutors themselves, will at times find an answer to this question in the subpoena or by how agents contact the healthcare provider.
One of the top priorities when we launch our Emergency Defense Package is determining if the investigation is civil or criminal.
What is the Emergency Defense Package?
Targets often learn about their alleged involvement when federal agents show up to serve a subpoena or to inspect the premises with a search warrant. When that’s the case, timing is imperative.
Over the years, Dr. Nick Oberheiden and his team have developed certain protocols that allow them to take immediate action. These protocols work because they provide important steps toward making a huge difference in outcome. They may even turn a case from possible criminal to civil.
- General Protocols: What to Do
- Instructions for Management: How to Deal with Agents
- Instructions for Management: How to Deal with Employees
- Instructions for Employees
- Document Retention Forms
- Compliance Examination Instructions
- Important Contact Information
DOL Cases and Experience
The DOL fraud defense attorneys of Oberheiden, P.C. know how to protect you, your livelihood, and your family. Healthcare fraud and DOL program fraud are serious accusations. You can expect a serious defense approach from us.
The Oberheiden, P.C. team works in a great variety of healthcare fraud cases and in DOL healthcare fraud cases in particular. We are retained to defend physicians, healthcare business owners, and patients against healthcare fraud, bribery, and anti-kickback violations. We have won numerous cases resulting in no civil and no criminal liability for our clients.
Contact Oberheiden, P.C. online today.
Which agencies are involved in healthcare investigations?
Most DOL healthcare investigations are led by agents and special agents of the OIG and the U.S. Postal Service.
How long does it take to resolve the investigation?
It depends on the seriousness of the charges, whether the case is civil or criminal, and the role of the client in the case.
What experience do you have with DOL cases?
Oberheiden, P.C. has been involved in some of the largest and the most complex DOL investigations in the country.
Who will handle my case at Oberheiden, P.C.?
We value personal attention and communication with our clients. All cases will be handled by senior attorneys.
Who will represent me?
We do not use paralegals or junior lawyers and all clients are represented by a team effort, led by former federal prosecutors and experienced healthcare attorneys.
What are the penalties for DOL Fraud in civil cases?
In civil DOL cases, the government can demand return of overpayments plus damages and penalties. The amount of penalties, if applicable, may be negotiated down by our experienced attorneys.
What are the penalties for DOL Fraud in criminal cases?
Prosecutors attempt to charge a healthcare company’s responsible owners and staff with healthcare fraud under 18 U.S.C. § 1347. Each count under the law carries a maximum sentence of 10 years in prison.
Oberheiden, P.C. has successfully appeared in some of the largest DOL investigations in the country. In many healthcare fraud cases, our attorneys were able to obtain no civil or criminal liability results for our clients and were able to dismiss the government’s case in its entirety. Contact us today to speak with an experienced attorney.
DOL Fraud Lawyers – DOL Investigation Defense – Oberheiden, P.C.