Boise Healthcare Fraud Defense - Federal Lawyer
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Boise Healthcare Fraud Defense

Dr. Nick Oberheiden
Attorney Nick Oberheiden
Boise Healthcare Defense
Team Lead envelope icon Contact Nick
Boise address – by appointment only:
800 W. Main Street Suite 1460
Boise, ID 83702
888-680-1745

As the costs of healthcare continue to skyrocket, the federal government has taken an increasingly aggressive approach whenever it detects signs of health care fraud in the system, including in Boise, Idaho. Unfortunately, that eagerness to prosecute has gotten many innocent healthcare providers caught in the crosshairs of federal and state fraud investigations. Even if they are able to overcome the allegations of defrauding the healthcare system, the costs of raising an effective defense can be substantial.

The healthcare defense attorneys at Oberheiden P.C. have legally represented numerous healthcare clients: healthcare professionals, physician groups, ambulatory surgery centers, hospital systems, and other organizations in the healthcare industry in Boise, Idaho, and the rest of the state. No matter what juncture your case is in – whether you have already been criminally charged by federal prosecutors for fraud or want to take the steps to ensure that you never are – the legal advice that we can provide can make a huge difference in the outcome and your future.

The Many Varieties of Healthcare Fraud

Healthcare fraud is an extremely broad term, encompassing virtually every deceitful or misleading way to extract money from the healthcare system. The vagueness of the term is necessary, as the law needs to cover new and creative methods of defrauding the system, but also problematic, as novel and potentially lucrative business practices could be seen as fraudulent by authorities.

However, some of the most common and widely-used methods of defrauding the healthcare system and violating fraud and abuse laws include:

  • Kickbacks: The practice of giving or receiving financial compensation for referring a patient to a particular healthcare practice or provider is outlawed by federal law in the Anti-Kickback Statute
  • Self-referrals: In the past, physicians used to have ownership stakes in multiple healthcare practices in an area and then increase their earnings by referring patients solely to the practices that they owned. This is now prohibited by the Stark Law
  • Billing fraud: One of the most common ways to defraud the healthcare system is to manipulate the billing process to extract as much money from it as possible. Some of the most common techniques for committing billing fraud have been:
    • Providing medically unnecessary care in order to bill the patient’s insurance company for it
    • Billing for services that were not rendered
    • Billing an insurance company for a patient who does not actually exist, or who has recently died
    • Upcoding, which is the practice of providing one medical service and then billing the insurance company for one that is similar, but more expensive
    • Unpacking or unbundling, which is the practice of taking several medical services that are normally billed together at a discount, splitting them apart, and billing for each one individually
  • False Claims Act: When knowingly incorrect claims for compensation are made against any government entity, it can violate the False Claims Act. This includes bills for compensation made against a government healthcare insurance program, such as Medicare or Medicaid
  • Prescription fraud: There are a variety of ways to commit prescription fraud, from a pharmacist billing for prescriptions that were not filled or dispensed to selling controlled drugs, like opioids, without a prescription being provided, or filling such a prescription knowing that the drugs are going to get abused or resold

Committing one of these types of fraud is especially problematic if it is done against a federal healthcare insurance program. If done against a private insurer, the insurance company will take action against you and impose sanctions like program exclusion and attempts to recoup the funds. If insurance fraud is done against a public insurer, it becomes a federal crime. This means law enforcement is likely to get involved and government investigations leading to criminal charges are far more likely.

Put our highly experienced team on your side

Dr. Nick Oberheiden
Dr. Nick Oberheiden

Founder

Attorney-at-Law

Lynette S. Byrd
Lynette S. Byrd

Former DOJ Trial Attorney

Partner

Brian J. Kuester
Brian J. Kuester

Former U.S. Attorney

Amanda Marshall
Amanda Marshall

Former U.S. Attorney

Local Counsel

Joe Brown
Joe Brown

Former U.S. Attorney

Local Counsel

John W. Sellers
John W. Sellers

Former Senior DOJ Trial Attorney

Linda Julin McNamara
Linda Julin McNamara

Federal Appeals Attorney

Aaron L. Wiley
Aaron L. Wiley

Former DOJ attorney

Local Counsel

Roger Bach
Roger Bach

Former Special Agent (DOJ)

Chris Quick
Chris J. Quick

Former Special Agent (FBI & IRS-CI)

Michael S. Koslow
Michael S. Koslow

Former Supervisory Special Agent (DOD-OIG)

Ray Yuen
Ray Yuen

Former Supervisory Special Agent (FBI)

Allegations of Fraud Can Be Civil or Criminal, Requiring a Savvy Defense Strategy

The crime of fraud requires a specific intent to defraud the victim. That intent can be very difficult for prosecutors to prove in some cases. However, that does not mean that you can only be penalized if prosecutors prove that you had the necessary level of intent: You can still face civil or administrative sanctions, and you can get penalized for mistakes or accidents that led to you or your company getting paid more than what it should have gotten.

Worse, federal agencies can pivot from criminal charges to civil ones based on what they find in their investigation.

For example, imagine a doctor’s office that bills Medicaid for services rendered to its patients. The Centers for Medicaid Services (CMS) discovers that these bills are inflated because the office always upcodes a specific procedure to one that is more expensive. CMS refers the case to the Department of Justice (DOJ) for criminal prosecution. The DOJ files criminal charges for healthcare fraud against the doctor’s office, but during its investigation the DOJ quickly learns that the medical billing professional did not know that they were committing fraud – they legitimately thought that they were correctly billing for the procedure.

In this case, the DOJ can drop the criminal charges, knowing that they will not be able to prove the necessary level of intent to defraud Medicaid, but then refile the case in civil court and demand the doctor’s office recoup Medicaid all of the money that had been paid for the upcoded procedures.

Because of this potential plot twist in the case, effective legal defenses in criminal cases must position the defendant in ways that do not undermine their case, should it be lowered to a civil lawsuit. This is not always easy, and is something that inexperienced healthcare fraud defense attorneys do with alarming frequency. In some cases, their defense to the criminal charges effectively confess to civil liability, costing the health care providers thousands of dollars in financial penalties.

Some Strategies Oberheiden P.C. Use

Every case is unique, with the particular circumstances and even the varying interests of the defendant playing a role in what the optimal defense strategy would be. However, for healthcare fraud allegations, the defense strategy needs to insulate you and your company from both criminal and civil liability.

Oftentimes, the best way to do this is to proactively engage in the investigation when it is at its earliest stages. By intervening and disclosing exculpatory evidence to investigators at this juncture, you may be able to persuade them that what they thought was criminal behavior was actually a law-abiding business practice. If successful, this defense strategy can avoid most of the expense and stress of the investigation, and can even prevent the civil or criminal charges from ever being filed.

Frequently Asked Questions About Healthcare Fraud Defense in Boise

What are the Penalties for Committing Healthcare Fraud?

The consequences of a criminal conviction, or even just a finding of civil liability, for healthcare fraud are substantial.

Depending on the nature of the offense, criminal convictions can carry multiple decades in prison, plus significant fines and other financial penalties, restitution payments, lengthy stints on probation after the prison sentence is served, severe reputational harm for both you and your healthcare business, the collateral consequences of having a criminal record, revoked medical licenses and certifications, and exclusion from the insurance program that was defrauded.

Civil liability comes with all of these setbacks, minus the prison time, probation, and the fallout from having a criminal record.

Avoiding these consequences is paramount.

What Makes Oberheiden P.C. Different?

Oberheiden P.C. does several things differently than other law firms in Boise, Idaho. Primary among them is that we do not employ anyone except for senior-level lawyers with numerous years of experience in their field.

When you look for a healthcare defense firm to represent you and your business, other firms will tout the experience of their partners and senior associates, many of whom will have lots of experience handling cases just like your own. However, if you hire the firm to represent you, you will see that the vast majority of the work on your case gets delegated to a junior associate or even to a paralegal. You may not interact at all with the senior lawyers – the ones whose experience drew you to the firm in the first place – until the culmination of your case. They may claim to have been overseeing it from the start, but how much they were involved in it is often unclear.

That does not happen at Oberheiden P.C. because it cannot happen at Oberheiden P.C.

We only employ senior attorneys, so it is impossible for us to delegate the work on your case to a junior associate or paralegal. We think the attention to detail and the experience that our attorneys bring to every detail of your case makes a big difference in the outcome.

Why Don’t You Call Yourselves the Best Healthcare Fraud Defense Firm in Boise, Idaho?

This is something that we prefer to let our prior clients say about us. It means more when it comes from them, anyway. You can read their testimonials here.


Contact the Healthcare Fraud Defense Team at Oberheiden P.C.’s Boise, Idaho, Office

The healthcare fraud defense lawyers at Oberheiden P.C. represent individuals and businesses in and around Boise, Idaho. Contact them online or call their national intake hotline at (888) 680-1745.

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