Pharmacy Medicaid Fraud Defense
Defense Lawyers for Pharmacists and Health Care Providers Accused of Pharmacy Medicaid Fraud
Our lawyers defend pharmacies, pharmacists, and other healthcare providers accused of Medicaid fraud across the country. We handle state and federal investigations as well as administrative, civil, and criminal enforcement proceedings. In all cases, early intervention is critical, so we strongly encourage you to contact us right away.
Oberheiden P.C. is a federal healthcare fraud defense law firm that represents pharmacies, pharmacists, and other healthcare providers accused of pharmacy-related Medicaid fraud. While these accusations will expose pharmacies and other providers to civil penalties in most cases, they have the potential to lead to criminal charges as well.
Former U.S. Attorneys and DOJ Prosecutors Experienced in Pharmacy Medicaid Fraud Cases
With a defense team that includes former United States Attorneys, Assistant United States Attorneys, and U.S. Department of Justice (DOJ) prosecutors focused on healthcare fraud cases, we have deep knowledge of how the federal government and state agencies handle these types of cases. We have a proven track record of successfully defending pharmacists, physicians, and other providers across the health care industry, and we are committed to protecting medical professionals’ reputations and careers.
Common Health Care Fraud Allegations Against Pharmacies and Providers
Medicare and Medicaid fraud investigations targeting pharmacies and other providers can involve a wide range of allegations. Some of the most common allegations in these cases include:
Controlled Substances Act Violations
The Controlled Substances Act and related federal laws such as the Drug Supply Chain Security Act (DSCSA) impose strict requirements and prohibitions for pharmacies and prescribing physicians. From improperly prescribing and accounting for prescription medicines to illicit drug diversion, prosecutors can pursue a wide range of federal charges under these statutes.
False Claims Act Violations
The False Claims Act prohibits pharmacies and other providers from improperly billing Medicaid for prescription medicines and related healthcare services. Billing Medicaid for prescriptions that lack medical necessity, upcoding, and other billing errors can expose pharmacists and other providers to substantial civil or criminal penalties, including prison time in some cases.
Anti-Kickback Statute Violations
The Anti-Kickback Statute prohibits the payment of referral fees and other forms of remuneration out of Medicaid-reimbursed funds. Anti-Kickback Statute violations can also create exposure to civil or criminal penalties; and, while the statute’s enabling regulations establish several safe harbors, transactions must generally be structured with a specific safe harbor in mind to avoid potential exposure.
Stark Law Violations
The Stark Law applies specifically to doctors and related entities, including related pharmacies. While the Stark Law also prohibits unlawful referral fees, it only includes provisions for civil penalties. Even so, the costs of noncompliance can be substantial, and doctors accused of pharmacy-related Medicaid fraud under the Stark Law must be prepared to defend themselves by all means available.
Matters We Handle
We handle all administrative, civil, and criminal matters involving allegations of pharmacy-related Medicaid fraud. These are high-stakes matters that require experienced legal representation.
Federal and state agencies and auditors are increasingly using data mining and extrapolation to identify billing anomalies, and this can lead to serious (yet unwarranted) allegations. As a result, when facing scrutiny, time is of the essence—as an informed and proactive defense is critical, and as early intervention can drastically reduce the risk of facing unwarranted negative outcomes.
Within our Medicaid fraud defense practice, we represent pharmacies, pharmacists, and other providers that are facing scrutiny from authorities including:
U.S. Department of Health and Human Services Office of Inspector General (HHS OIG)
The U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) investigates all suspected forms of Medicaid billing fraud involving pharmacies and other healthcare providers. This includes improperly billing for prescription medicines and medically unnecessary services, as well as paying (and receiving) unlawful rebates and referral fees.
U.S. Department of Justice (DOJ)
The U.S. Department of Justice (DOJ) also investigates all suspected forms of Medicaid billing fraud, as well as suspected drug-related offenses. The DOJ prosecutes all criminal Medicaid fraud cases, and it has been prioritizing criminal enforcement in recent years. If you have received a search warrant, subpoena, or target letter from the DOJ, you should contact a lawyer immediately.
U.S. Drug Enforcement Administration (DEA)
The U.S. Drug Enforcement Administration (DEA) investigates suspected violations of the Controlled Substances Act and DSCSA. While the DEA refers cases to the DOJ for criminal prosecution when warranted, it also has the authority to revoke pharmacies’ registrations and impose other administrative penalties. In many cases, DEA investigations targeting prescription drug diversion and HHS OIG/DOJ investigations targeting Medicaid billing fraud will go hand-in-hand.
Medicaid Fraud Control Units (MFCUs)
We handle cases involving Medicaid Fraud Control Units (MFCUs) as well. MFCU investigations can also lead to referrals to the DOJ; and, as a result, these investigations present the same risks as those involving federal law enforcement agencies. Several of our lawyers have significant experience in the area of MFCU defense, and we can provide representation on an emergency basis when necessary.
We Also Defend Pharmacies and Other Providers Accused of Medicare Fraud
Along with handling healthcare fraud investigations and prosecutions targeting allegations of Medicaid fraud, we handle Medicare fraud matters as well. If you are facing scrutiny from a Medicare Fraud Control Unit, the DOJ’s Medicare Fraud Strike Force or any of the other entities listed above related to your pharmacy’s billing, rebate, or dispensing practices, we can defend you in this scenario as well.
FAQs: Defending Against a Pharmacy Medicaid Fraud Investigation
What are the potential penalties for pharmacy Medicaid fraud?
The penalties for pharmacy Medicaid fraud depend on the specific allegations involved, as well as whether these allegations are civil or criminal in nature. In civil enforcement cases under the False Claims Act and other federal laws, pharmacies and other providers can face substantial fines (up to $50,000 per violation in some cases), as well as liability for recoupments and treble damages. Medicaid exclusion is a very real risk as well. In criminal cases, federal prison time is also on the table.
For pharmacists and other licensed providers, loss of their professional license is also a very real concern. Our lawyers can assess the circumstances at hand to determine what is at risk in your case, and then we can use our experience to protect your interests by all means available.
When can pharmacies (and pharmacists) face criminal charges for Medicaid fraud?
To pursue criminal charges for Medicaid fraud, the government must be able to prove that the fraudulent act in question was committed knowingly. If you inadvertently overbilled Medicaid or accepted an unlawful referral fee, you may be liable for recoupments or civil penalties, but you do not deserve to face criminal charges in federal court.
What should I do if my pharmacy has improperly billed Medicaid?
If your pharmacy has improperly billed Medicaid, the steps you need to take depend on whether an audit or investigation is already underway. If an audit or investigation is not already underway, voluntary self-disclosure could be the best approach for mitigating your pharmacy’s penalties. With that said, voluntary self-disclosure requires a very cautious approach, and you should consult with legal counsel before doing anything that could trigger federal scrutiny.
If the HHS OIG, DOJ, an MFCU, or another governmental authority is already looking into your pharmacy’s Medicaid billing practices, this is another matter entirely. In this scenario, you need to focus on building a comprehensive defense strategy, and you will need to engage experienced defense counsel who can help steer the inquiry toward a favorable resolution.
What should I do if my pharmacy is under investigation for Medicaid fraud?
If your pharmacy is under investigation for Medicaid fraud, there are several important steps you need to take immediately. These include (but are by no means limited to): (i) locating and preserving all relevant billing, prescription, and compliance records; (ii) conducting an internal Medicaid billing compliance assessment; and, (iii) formulating an informed and cohesive defense strategy that is tailored to the specific circumstances at hand. All of these require the advice and insights of experienced defense counsel, and you should consult with an experienced pharmacy Medicaid fraud defense lawyer before doing anything that could jeopardize your defense.
Do I need a lawyer if federal agents are inquiring about my pharmacy’s Medicaid billing or prescription practices?
Yes, if federal agents have contacted you about your pharmacy’s Medicaid billing or prescription practices, you should contact an experienced lawyer right away. Prescription-related Medicaid fraud investigations can lead to fines, recoupments, exclusion, professional discipline, and prison time—and these are just examples of the consequences that could be on the table.
Schedule a Free Consultation with a Pharmacy Medicaid Fraud Defense Lawyer at Oberheiden P.C.
If you need defense counsel for a pharmacy Medicaid fraud investigation, we strongly encourage you to contact our law offices right away. We have extensive experience in this area, and we are available to handle Medicaid fraud cases across the country. To arrange a free and confidential consultation with a senior lawyer at Oberheiden P.C., call 888-680-1745 or contact us confidentially online today.
Additional Medicaid Pages
- Medicaid Fraud Lawyer
- Physician’s Group Settles Medicaid False Billing Claim Related to Sleep Studies
- CMS Medicaid Suspension Defense and Medicare Suspension Defense
- Medicaid Preventive Health Care Fraud Defense
- Medicaid Autism Services Fraud Defense
- Medicaid Dental Care Fraud Defense
- Medicaid Hospice Benefits Fraud Defense
- Medicaid Alternative Benefit Plan Fraud Defense
- Medicaid Transportation Coverage Fraud Defense
- Medicaid Reentry Services Fraud Defense
- Medicaid Mandatory Benefits Fraud Defense
- Medicaid Early and Periodic Screening Fraud Defense
- Medicaid Behavioral Health Services Fraud Defense
- Medicaid Fraud Defense for Hospice Businesses
- New York Medicaid Fraud Defense
- California Medicaid Fraud Defense
- Minnesota Medicaid Fraud Defense
- Telehealth Medicaid Fraud Defense
