Broken Arrow, Oklahoma Healthcare Fraud Defense Attorneys
Former U.S. Attorney
Contact Brian629 W. Main Street
Oklahoma City, OK 73102
405-504-3811
Federal regulators and law enforcement agents have prior09.15.2023itized the prosecution of healthcare fraud in the past several years, mainly due to political pressure to tamp down the rising costs of healthcare in the U.S. However, the costs of creating tighter compliance protocols, handling intrusive investigators, and defending against groundless allegations of fraud makes it extremely difficult for healthcare providers in Broken Arrow, Oklahoma, to continue to function.
The Broken Arrow, Oklahoma healthcare fraud defense lawyers at the national law firm Oberheiden P.C. are fully aware of the problem, and strive to legally represent healthcare professionals in Broken Arrow through all of the stages of the process – from creating compliance strategies to protecting individuals and companies during an inquiry to defending against claims of healthcare fraud.
Dispelling a Myth: Healthcare Fraud Requires an Intent to Defraud
A pervasive myth about healthcare fraud law is that you can only be held liable if you acted with the knowledge and intention of defrauding an insurer. However, there is an important piece of nuance that this myth does not include, and that makes it dangerously misleading: You can only be held criminally liable for healthcare fraud if you acted with intent. Our Broken Arrow, Oklahoma healthcare fraud defense attorneys play a critical role in navigating the perilous landscape of federal investigations targeting healthcare providers. You can still risk civil penalties of healthcare fraud if you did not intend to defraud an insurance program out of money, and the insurer can still take actions against you for completely accidental conduct. Even if the billing errors that overcharged an insurance program were mistakes, that does not mean that the insurance program cannot recover the excessive amounts that it has paid out.
The Three Different Types of Enforcement Actions
Broadly speaking, there are three different ways that insurance companies and law enforcement agencies can react when they detect signs of healthcare fraud in Broken Arrow, Oklahoma. They can:
- File criminal charges
- File a civil lawsuit
- Pursue administrative sanctions
Only law enforcement agencies can file criminal charges, and convictions typically require sufficient evidence to prove, beyond a reasonable doubt, that you acted with the specific intent to defraud the insurance program. If convicted for healthcare fraud, you can face years in prison, massive financial penalties, and the collateral consequences of having a conviction on your criminal record, which can include a revocation of your medical license.
More often, though, healthcare fraud allegations come in the form of civil claims, often under the federal False Claims Act (31 U.S.C. §§ 3729 – 3733) when the insurance program at issue is one that is funded by the government. While civil allegations of healthcare fraud do not carry prison time, the financial repercussions of litigation against you can be massive. If filed under the False Claims Act, for example, you may be liable for treble damages, or three times the amount that the allegedly fraudulent conduct obtained. Furthermore, civil liability does not require proof that you acted with an intent to defraud an insurer. Liability under the Act, for example, only requires that you acted knowingly.
Finally, private insurers as well as the Centers for Medicare and Medicaid Services (CMS) can pursue administrative remedies when they detect signs of healthcare fraud. Because these actions do not go through court, first, they can follow accidental billing errors or mistakes. These enforcement actions demand recoupment of the alleged overpayments and can take other actions against you that can affect your future billing process, like requiring prior approval before payments are made. If the alleged overcharges were large enough or happen frequently enough, the insurance program may exclude you, preventing you from treating patients that are insured through the program.
Put our highly experienced team on your side
Dr. Nick Oberheiden
Founder
Attorney-at-Law
Lynette S. Byrd
Former DOJ Trial Attorney
Partner
Brian J. Kuester
Former U.S. Attorney
Hon. Kevin McCarthy
55th Speaker, U.S. House of Representatives (ret.)
Government Consultant
Mike Pompeo
Of Counsel
Former U.S. Secretary of State
John W. Sellers
Former Senior DOJ Trial Attorney
Linda Julin McNamara
Federal Appeals Attorney
Nicholas B. Johnson
Former Prosecutor
Roger Bach
Former Special Agent (DOJ)
Chris J. Quick
Former Special Agent (FBI & IRS-CI)
Michael S. Koslow
Former Supervisory Special Agent (DOD-OIG)
Ray Yuen
Former Supervisory Special Agent (FBI)
Numerous Federal Laws Cover Healthcare Fraud
When the allegedly defrauded insurer is run by the government, like Medicare, Medicaid, or Tricare, then federal law enforcement agencies and regulators can get involved from the:
- Centers for Medicare and Medicaid Services (CMS)
- Office of Inspector General at the Health and Human Services Department (HHS-OIG)
- Department of Justice (DOJ)
- Federal Bureau of Investigation (FBI)
- Drug Enforcement Administration (DEA)
These agencies have a variety of federal laws that they can enforce to protect these government-funded health insurance programs. Some of them carry the potential for criminal liability, though most focus on civil enforcement.
Implementing robust compliance programs can assist healthcare practitioners to avoid violations of these federal laws.
Healthcare Fraud Statute
18 U.S.C. § 1347 is the broad federal statute that makes it a crime to obtain money from a health insurance program through the willful or knowing use of false promises, pretenses, or representations. Convictions carry up to 10 years in prison. Hiring an experienced Broken Arrow, Oklahoma healthcare fraud defense lawyers is crucial for defending against charges under this statute.
Additionally, 18 U.S.C. § 1349 covers conspiracy to commit healthcare fraud. Even if you were not the one to actually use false pretenses to get money from a federally-funded healthcare program, if you were involved in a scheme to do so, you can still get charged with a crime.
False Claims Act
The federal False Claims Act is likely the most common statute to pursue civil liability for committing healthcare fraud. While its scope is much broader – it forbids knowingly filing fraudulent claims for compensation of any sort with the government – it is frequently applied to the healthcare field. Law enforcement agencies like to use the False Claims Act because it provides for treble damages. The potential for paying such a high amount is often used as pressure to get you to settle the case on terms that you might not otherwise have agreed to.
There is also a criminal False Claims Act (18 U.S.C. § 287), which carries up to five years in prison for a conviction.
Statutes Prohibiting Kickbacks and Self-Referrals
While most allegations of healthcare fraud revolve around deceptive billing and fraudulent overcharges against an insurer, the field also includes illegal kickbacks and self-referrals by medical professionals.
The Stark Law (42 U.S.C. § 1395nn) covers self-referrals. It forbids medical professionals from making certain types of referrals to other medical providers if that medical professional has a financial stake in that other provider. While there are safe harbors and exceptions that carve a lot out from this general rule, the Stark Law is a strict liability statute: Prosecutors do not have to prove that you acted with any level of intent, so accidental violations still carry civil liability and allegations under the law are relatively easy to prove.
Kickbacks, meanwhile, are forbidden by two federal statutes:
- Eliminating Kickbacks in Recovery Act (EKRA) (18 U.S.C. § 220)
- Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b))
Violations of the Anti-Kickback Statute are felony offenses.
Frequently Asked Questions About Healthcare Fraud in Broken Arrow and How Oberheiden P.C. Can Help You
What Billing Errors Frequently Lead to Healthcare Fraud Allegations?
Any billing discrepancy that overcharges an insurance program can lead to fraud allegations. If a subsequent probe by the insurer or law enforcement agents uncovers evidence of an intent to defraud or that you knew of the overcharge, it can lead to civil or criminal allegations. Some common billing issues that lead to legal liability include:
- Double billing, where multiple bills for reimbursement are submitted to the insurance company for a single event
- Upcoding, where one medical procedure or treatment is provided to the patient, but then the bill to the insurer uses a code for a different and more expensive procedure
- Unpacking, where the medical provider unbundles a group of medical procedures that are typically billed together and at a discount, charging the insurer for each one individually and at its normal price
- Phantom billing, where bills are submitted for patients or medical professionals that do not exist
Additionally, billing for medically unnecessary care can also lead to suspicions and investigations for healthcare fraud. These instances often devolve into extremely technical debates about what level of medical care was appropriate in the circumstances.
What Makes Oberheiden P.C. Different Than Other Healthcare Fraud Defense Firms in Broken Arrow?
At Oberheiden P.C., we do several things differently than our competitors. The most important is likely how we structure our law firm.
Other law firms have a couple of partners with lots of experience. Beneath them, there are often dozens of junior associates who have only just begun to practice the law. Then there are many more paralegals who perform lots of the mundane legwork on cases for clients that come to the firm. In many cases, those clients are attracted to the firm because of the experience of the partners, only to see the work on their case get delegated to attorneys further down the ladder, often with minimal oversight from the firm’s more experienced lawyers.
At Oberheiden P.C., we only employ senior-level lawyers with lots of experience handling healthcare fraud cases like yours. This means that all of the work gets done by a Broken Arrow, Oklahoma healthcare fraud defense attorney whose experience drew you to us, and you can rest assured that this is the case because we do not have junior associates or paralegals at Oberheiden P.C.
Why Doesn’t Oberheiden P.C. Call Itself the Best?
We would rather let the testimonials from our prior clients say these sorts of things.
Oberheiden P.C.: Strong Healthcare Fraud Defense Lawyers Serving Broken Arrow, Oklahoma
If you or your healthcare business is under investigation for healthcare fraud, you need strong legal advocacy, and you need it now. A proven Broken Arrow, Oklahoma healthcare fraud defense lawyer is crucial in protecting the interests of healthcare professionals like you. The first steps that you take after learning of an investigation will make a huge difference in the outcome of your case.
Call the strong defense lawyers at Oberheiden P.C. at (888) 680-1745 or contact them online to learn your rights and the best way to approach your situation.
