Anaheim Federal Healthcare Fraud Defense Lawyer
Federal authorities are targeting Anaheim healthcare providers in fraud investigations. Fraud can lead to civil monetary penalties, criminal fines, treble damages, healthcare benefit program exclusion, and even federal imprisonment. Providers should seek to lower the risk of a disastrous judgment in civil or criminal court. Experienced legal counsel can help in these matters.
155 N. Riverview Drive
Anaheim Hills, CA 92808
Oberheiden, P.C., is a federal defense law firm. Our Anaheim federal healthcare fraud defense lawyers represent a great variety of medical providers with federal benefit fraud allegations. Our firm has a national presence. Our healthcare fraud attorneys are available to meet with new clients in Anaheim, CA. If your business or practice is targeted by:
- U.S. Department of Justice (DOJ),
- Drug Enforcement Administration (DEA),
- Internal Revenue Service (IRS),
- Office of Inspector General (OIG), or any other federal agency, you need experienced attorneys to represent you.
We can help with alleged billing violations, illegal kickbacks, prescription drug diversion, or any other form of federal healthcare fraud. Our firm is available to take action in your case immediately.
Examples of our experience include:
- Representation of a healthcare provider and its principals in a federal fraud investigation involving the DOJ and FBI. Outcome: No civil or criminal liability.
- Representation of a healthcare provider and its principals in a federal fraud investigation involving the DOJ and OIG. Outcome: No civil or criminal liability.
- Representation of a healthcare provider and its principals in a federal fraud investigation involving the FBI and OIG. Outcome: No civil or criminal liability.
- Representation of a healthcare provider and its principals in a DOJ investigation following the issuance of a Medicare fraud subpoena by the OIG. Outcome: No civil or criminal liability.
- Representation of a healthcare provider and its principals in a large-scale criminal investigation involving numerous federal law enforcement agencies. Outcome: No civil or criminal liability.
What Is Healthcare Fraud?
If all you know is that you are under investigation for healthcare fraud, you only know part of the story. If your practice or business gains the government’s attention, federal agents and prosecutors are looking into very specific allegations against you. Each case is unique, but typical allegations of medical fraud include:
- Billing for medically-unnecessary services, supplies, or equipment
- Billing for services or supplies not actually rendered to patients
- Controlled Substances Act and DEA registration violations (e.g., prescription drug fraud or opioid diversion)
- Falsifying patient records, prescriptions, physician certifications, or election statements
- Double-billing the government and/or a private insurance company
- Upcoding or unbundling services or supplies in order to secure a higher reimbursement rate
- Other billing or coding violations
- Anti-Kickback Statute violations (unlawful kickbacks or referral fees)
- Stark Law violations (physician “self-referrals”)
To determine allegations against you, the first step is to intervene in the probe. When you engage Oberheiden, P.C., we will promptly make contact with the federal authorities handling your case in order to uncover:
- Which federal agencies are involved in the investigation?
- What triggered government interest (eg., automated comparative analysis of billing data or a “whistleblower” complaint)?
- How long has the investigation been ongoing?
- What types of information are the federal agencies seeking to collect?
- Is the investigation civil or criminal in nature?
- How close are federal prosecutors to filing civil charges or seeking an indictment?
The sooner we gather this information, the sooner we can start protecting you. This will also give us a greater chance to resolve your case before charges are filed. To get started with a free and confidential case assessment, call 888-680-1745 or contact us about your Anaheim healthcare fraud investigation online now.
1. The False Claims Act
Under the False Claims Act (FCA), healthcare providers can be prosecuted for both intentional and unintentional submission of “false or fraudulent” claims. Unintentional violations carry the potential for substantial monetary fines and program exclusion. Criminal violations carry fines and up to five years in prison for each offense. Financial penalties apply on a “per-claim” basis. Total liability in an FCA case can easily reach six or seven figures.
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) prohibits offering, paying, soliciting, or receiving referral fees or other goods and services in connection with federal healthcare benefit program referrals. This includes referrals for beneficiaries of Medicare, Medicaid, Tricare, and the DOL. The Anti-Kickback Statute also includes provisions for both civil and criminal prosecution. It carries penalties similar to those imposed under the False Claims Act.
3. The Stark Law
The Stark Law prohibits physicians who participate in Medicare and Medicaid from engaging in so-called “self-referrals.” A self-referral is a referral for program-reimbursed business provided to (or received from) a related entity. It involves any of the following designated health services:
- Clinical laboratory services
- Physical therapy services
- Occupational therapy services
- Outpatient speech-language pathology services
- Radiology and certain other imaging services
- Radiation therapy services and supplies
- Durable medical equipment and supplies
- Parenteral and enteral nutrients, equipment, and supplies
- Prosthetics, orthotics, and prosthetic devices and supplies
- Home health services
- Outpatient prescription drugs
- Inpatient and outpatient hospital services
The Stark Law is a civil statute. Potential penalties include recoupments, civil monetary penalties, treble damages, and permanent loss of Medicare or Medicaid participation.
4. The Controlled Substances Act
The Controlled Substances Act carries criminal penalties for fraudulent prescription practices, drug diversion, improper filling of prescriptions, and other forms of pharmaceutical fraud. Providers who violate the Controlled Substances Act can have their DEA registrations revoked. They can also face criminal prosecution in federal district court.
5. The Federal Healthcare Fraud Statute
The healthcare fraud statute, 18 U.S.C. 1347, makes it a crime to “knowingly and willfully . . . (1) . . . defraud [or attempt to defraud] any healthcare benefit program; or (2) . . . obtain [or attempt to obtain] by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any healthcare benefit program.” While this language echoes the prohibitions of the False Claims Act and the other statutes listed above, 18 U.S.C. 1347 imposes possible prison sentences of 10 years, 20 years, or life behind bars, depending upon the existence and extent of any harm to patients resulting from a provider’s violations.
6. Other Federal Criminal Statutes
In addition to these statutes, in criminal healthcare fraud cases, prosecutors with the U.S. Attorney’s Office will often file charges for a number of other statutory offenses as well. These include:
- 18 U.S.C. 371 (criminal conspiracy)
- 18 U.S.C. 1028A (identity theft)
- 18 U.S.C. 1341 (mail fraud)
- 18 U.S.C. 1343 (wire fraud)
- 18 U.S.C. 1344 (bank fraud)
- 18 U.S.C. 1357 (money laundering)
- 21 U.S.C. 841 (distribution of controlled substances)
- 26 U.S.C. 7206 (tax fraud)
Why Choose Oberheiden, P.C., for Your Federal Healthcare Fraud Case in Anaheim, CA?
The success or failure of your defense depends heavily on your choice of legal counsel. Why do healthcare providers in Anaheim, throughout California, and nationwide choose the federal healthcare fraud defense lawyers at Oberheiden, P.C.?
- Thousands of Investigations Handled. Collectively, our firm has represented clients in thousands of inquiries and hundreds of trials. We know what worked well in the past, and we use our experience to our clients’ advantage.
- Personal Attention by Senior Attorneys. All clients work directly with senior attorneys on our federal healthcare fraud defense team. We do not employ paralegals or junior associates.
- Available 24/7. When your future is on the line, you don’t have time to wait around. We make ourselves available to our clients 24/7.
- Focus on Pre-Charge Resolution. Whenever possible, we focus on resolving our clients’ cases prior to charges being filed. This keeps you in control and protects you against the inherent uncertainty of a trial.
- Skilled and Aggressive Trial Representation. Sometimes, you must fight for your right to practice at trial. If that is the case, our attorneys will use their extensive trial backgrounds to present an exhaustive defense.
Frequently Asked Questions
What is Medicare fraud?
Medicare fraud is any conduct intended to illegally bill the Medicare program. Medicare fraud lawsuits are so common that the term has nearly become synonymous with healthcare fraud. However, there are other types of healthcare fraud that do not involve Medicare. Common examples of Medicare fraud include:
- Fraudulent billing,
- Phantom billing, and
- Billing for services or supplies not provided.
If you face allegations of Medicare fraud or any other type of healthcare fraud, you must take action. It’s crucial to protect your interests by contacting an Anaheim, California federal healthcare fraud defense attorney today.
What should I look for in an Anaheim federal healthcare fraud defense attorney?
Healthcare fraud cases are extremely complex. It requires a knowledge of the applicable legal principles and the healthcare industry. You need a federal healthcare fraud defense attorney to protect you against the government’s allegations. Identify a lawyer who has specific experience successfully handling these particular cases. Firms with attorneys who worked as federal healthcare fraud prosecutors have insights into how the government builds and presents cases. The experience can be a tremendous advantage.
Which healthcare providers are most frequently targeted in federal healthcare fraud cases?
Careless bookkeeping or an innocent mistake can put the most well-intentioned provider at risk of prosecution. The federal government can pursue healthcare fraud charges against any type of provider. If you operate any of the following businesses and think you or your business is suspected of healthcare fraud, it’s important to find an Anaheim, CA federal healthcare fraud defense attorney:
- DNA testing facilities;
- Toxicologists and toxicology laboratories;
- Healthcare marketing agencies;
- Home healthcare agencies;
- Hospice providers;
- Outpatient surgical centers;
- Mobile healthcare clinics; and
- Drug rehabilitation facilities
Contact Oberheiden, P.C.
If you would like to speak with a member of our federal healthcare fraud defense team about your investigation in Anaheim, please call 888-680-1745 or request a free initial case assessment online. We will arrange for you to discuss your case with an Anaheim federal healthcare fraud defense attorney, in confidence, as soon as possible.