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Colorado Healthcare Fraud Defense Lawyer

Experienced Health Care Fraud Defense Lawyers Representing Medical Providers in Colorado

Former Justice Department Lawyers Defend Physicians and Business Owners in Colorado

United States citizens demand accountability from physicians, firms, and businesses that abuse government programs like Medicare and Medicaid. The same holds true for those who attempt to defraud the federal government. Agents from federal authorities such as the Federal Bureau of Investigation (FBI), the United States Department of Justice (DOJ), and the Drug Enforcement Administration (DEA) are tasked with investigating and prosecuting Colorado based healthcare providers and businesses suspected of fraud.

Those in the healthcare industry in Colorado should be ready to protect themselves against a federal healthcare fraud investigation. This includes ensuring you have access to experienced and knowledgeable legal counsel.

Contact the Former U.S. Prosecutors of Oberheiden, P.C.

Colorado Healthcare Fraud Defense Lawyer

When you or your business are the target of a federal health care fraud investigation, you need the experience of Oberheiden, P.C.. Our firm is composed of former DOJ and federal officials familiar with federal health care fraud investigations and audits. Our firm and its attorneys have participated in over 2,000 healthcare fraud investigations and audits. While we are proud of our firm’s successes, we are not bound by them. We use what worked for our clients in the past to develop new and innovative ways to defend you and your business.

Oberheiden, P.C.’s Experience Incorporates:

  • Over 2,000 health care fraud investigations
  • Over 2,000 grand jury proceedings
  • Countless federal and state criminal indictments dismissed
  • Over 70 years of combined Department of Justice experience

Current Health Care Fraud Investigations in Colorado

The DEA, the Office of the Inspector General (OIG), and the FBI are some of the federal agencies that investigate Colorado health providers and related enterprises. Violations of the Anti-Kickback Statute (42 U.S.C. 1320a-7b), the Stark Law (42 U.S.C. 1395nn), the Controlled Substances Act (21 U.S.C. 841, 846), and other similar statutes can result in civil penalties and, in some cases, criminal charges.

Audits & Compliance:

  • Medicare Audits & ZPIC Audits. Medicare Administrative Contractors (MACs) and Recovery Audit Contractors (RACs) finds payments made on improper or fraudulent claims. They analyze data from claims submitted to Medicare and compare it to information and records from the provider. Zone Program Integrity Contractors (ZPICs) audits are also tasked with uncovering potential healthcare fraud activity. They then refer such activity to the Department of Health and Human Services (HHS) and/or the OIG. These audits should be conducted by trained and objective specialists. However, mistakes in how these audits are conducted can and do happen. When mistakes are made, you and/or your business may face criminal charges from the United States Attorney’s Office. At Oberheiden, P.C., former DOJ prosecutors use the knowledge obtained working for federal agencies to help clients complete these and other government audits quickly. Hopefully, with as little disruption to their businesses as possible.

Health Care Fraud Investigations:

  • False Claims Act Violations. One common statute enforced against healthcare providers and others in the industry is the False Claims Act (FCA). Violations of the FCA occur when false claims for payment are submitted to government programs such as Medicare, Medicaid, and Tricare. It is not necessary for the “false and fraudulent” claim to be submitted with knowledge or intent to deceive. A violation of the False Claims Act occurs just because the claim was filed. A violation of the False Claims Act can result in civil fines and other penalties. Criminal sanctions are possible as well. If you or your business receive notice from the OIG that you are the subject of a False Claims Act investigation, contact Oberheiden, P.C. right away. We have successfully represented clients throughout the country who found themselves in a similar situation.
  • Physician “Self-Referrals” and Stark Law Violations. The Stark Law prohibits doctors from referring patients to a “related” healthcare provider or business in order to receive a financial benefit. You and your business may be heavily sanctioned if you violate the Stark Law. The Colorado healthcare fraud defense attorneys at Oberheiden, P.C. can help you defend yourself, your reputation, and your livelihood against these types of allegations.
  • Colorado Billing/Coding Mistakes. Medical billing can be complicated for large hospitals and solo health providers alike. Some common examples include:
    • Errors in billing or coding for services such as billing for procedures and treatments that are not medically necessary;
    • Upcoding a procedure or treatment so that it is compensated at a higher rate; or
    • Billing for procedures and services that were not actually provided to the patient.

    All of these activities can lead to civil and/or criminal penalties.

Criminal Defense:

  • Healthcare Fraud & Conspiracy to Commit Health Care Fraud. Under Title 18 U.S.C. Section 1347, Health care Fraud is defined as executing or attempting to execute a scheme or plan designed to defraud a “healthcare benefit program” or to obtain “any of the money or property owned by, or under the custody or control of” a healthcare benefit program through false representations. Successful prosecutions can lead to hefty fines and/or up to ten years in federal prison. These penalties may befall you and your business even if you did not make such deceptive representations. Sanctions follow if federal prosecutors can show you conspired with another person or business who did make false representations. Our firm zealously defends clients charged with healthcare fraud and conspiracy charges. Our healthcare fraud attorneys’ experience in working for the DOJ and other federal agencies gives them inside knowledge on how the government builds its cases and how a case can be defeated.
  • Prescription Drug & Opioid Abuse. Federal authorities have declared a national opioid abuse epidemic. Pharmacies, pharmacists, and doctors who prescribe and dispense opioids and other drugs are under scrutiny. Investigations can ensue if drugs are dispensed incorrectly, or if opioids are prescribed to those with a history of drug abuse. Oberheiden, P.C. can quickly intervene for healthcare providers accused of improper handling or dispensing prescription drugs and/or opioid medications.
  • Medicare Fraud and Medicaid Fraud. Intentionally defrauding or attempting to defraud the Medicare or Medicaid programs will almost certainly attract the attention and interest of federal investigators and prosecutors. Typical practices include:
    • Fraudulent coding or billing;
    • Submitting false credentials showing a provider is qualified to perform a particular service, when the provider is not; and
    • Seeking compensation for treatments and services that are not actually provided.

    If you discover that you and/or your practice are under investigation for Medicare or Medicaid fraud, contact us as soon as possible. Our firm has a solid history of assisting clients charged with such allegations and successfully resolving their civil and/or criminal defense matters. In some cases, we have been able to resolve our clients’ fraud charges with no criminal, nor civil penalties.

  • Illegal Kickbacks, Bribes, and Referral Fees. Some federal healthcare statutes prohibit actions by doctors or other health providers. The Anti-Kickback Statute (AKS), however, applies to anyone. A person who offers, solicits, pays, or receives compensation in exchange for a patient referral is subject to penalties and sanctions described in the AKS. This statute can be difficult for doctors, hospitals, and other similar businesses having a relationship with certain labs and pharmacies. Our experienced legal team is very familiar with the AKS along with the statute’s exceptions. We will work to provide you with an exceptional defense.

At Oberheiden, P.C., our Colorado healthcare fraud defense lawyers want to help you with a free, confidential, and no-obligation consultation. During your consultation, we will review the facts of your case. With that information, we will describe how we plan to resolve your situation efficiently and successfully. Learn the difference a healthcare fraud defense firm with over 70 years of combined experience working for federal prosecutors can make in your case. Call our firm and schedule your free initial consultation today.

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)

FAQs: What Colorado Providers Need to Know about Healthcare Fraud Investigations

Q: What healthcare medical providers are being investigated in Colorado?

No healthcare provider in Colorado should assume that he or she could never be the subject of a healthcare fraud investigation. A careless mistake or inadvertent error can draw the attention of federal auditors and investigators. As a result, the following health providers and related entities should strongly consider retaining the services of Oberheiden, P.C.:

  • Pharmacists and pharmacies;
  • DNA testing facilities;
  • Toxicologists and toxicology laboratories;
  • Marketing agencies;
  • Home healthcare and hospice businesses;
  • Hospitals and outpatient surgical centers; and
  • Drug rehabilitation facilities

Q: What coding and/or billing errors lead to healthcare fraud investigations?

There exists a perception that Medicare, Medicaid, and other federal health benefits programs are rife with fraud and abuse. This perception makes the federal government devote ample resources to ferret out those who commit such actions. Coding and billing errors and mistakes are common ways auditors and investigators learn of fraudulent schemes. Some errors and mistakes federal agents are trained to look for include:

  • Double-billing, where two or more federal healthcare benefits programs are billed for the same service or procedure;
  • Billing for treatment and procedures that are not actually rendered to the patient;
  • Submitting claims for treatment and procedures that are not permitted under the regulations of the benefits program or that are not medically necessary.

Q: How can I protect myself and/or my practice from allegations of prescription drug fraud or abuse?

Because of the opioid abuse epidemic plaguing the country, those who prescribe medications as well as the medical providers, pharmacists and pharmacies that fill those prescriptions are under intense scrutiny from federal agencies. Being accused of prescription drug fraud or abuse can jeopardize your financial resources, your license, your reputation, and even your freedom. Some activities and practices that lead to investigation and prosecution include:

  • Failing to follow laws and regulations regarding electronic or traditional prescriptions;
  • Prescribing medications – especially opioids – to patients with a history of drug abuse or addiction;
  • Prescribing medications to patients where there is no medical necessity for the medication;
  • Prescribing medications for medical conditions that the drug is not approved to treat.

Q: What sanctions are permitted for those found guilty of healthcare fraud?

In the past, healthcare fraud was primarily handled through the civil court system. Successful prosecutions resulted in fines and sanctions along with suspension or revocation of professional licenses. Now, these allegations often lead to criminal prosecution. Not only can criminal prosecutions carry fines and license suspension/revocation, but imprisonment for a period of years. It is critical for physicians, pharmacists, hospitals, and other health providers to treat fraud investigations and allegations seriously. Oberheiden, P.C. can assist you and your practice or business in responding effectively to allegations of healthcare fraud. We use our years of experience to customize a defense to minimize the potential effects of a fraud conviction.

Q: What other steps can I take to safeguard myself and my practice from healthcare fraud investigations and prosecutions?

Speak with the dedicated legal team at Oberheiden, P.C. to learn about how we can help you avoid being the target in a healthcare fraud investigation. If an investigation has already started, we may be able to assist in resolving your matter quickly.

Oberheiden, P.C. is skilled in handling complex health care fraud investigations and criminal defense cases. We have defended clients charged with Medicare or Medicaid fraud, violations of the False Claims Act, Stark Law offenses, and many other similar charges in Colorado and across the nation. Call us today to discuss your case and see how we can help.


Why Colorado Physicians, Dentists, Psychologists, private insurance companies, and Business Owners Choose Oberheiden, P.C.

There are many reasons to turn to Oberheiden, P.C. when you or your practice face charges stemming from violations of healthcare fraud statutes. Our clients choose our Colorado healthcare fraud defense attorneys because we offer:

  • Experience as former federal healthcare fraud prosecutors, that gives us a unique insight into how the government will build and present its case;
  • Proven results with many of our clients’ cases resulting in neither civil, nor criminal liability for our clients;
  • Attorneys who are familiar with federal laws pertaining to healthcare fraud; and
  • A collaborative approach that draws on our legal team’s vast and varied background to craft a successful plan to handle your case.

Do not gamble with your practice’s future. Seek immediate legal help from Oberheiden, P.C. if you are under investigation for healthcare fraud. Without prompt legal intervention, you may find your way of life, financial future, and very freedom and liberty at risk.

Oberheiden, P.C. handles health fraud cases from clients all over the United States. Our attorneys’ backgrounds as former healthcare fraud prosecutors with the DOJ and other agencies mean that we are usually able to provide superior results for our clients in less time.

Our approach to our clients’ cases is unique to each client. What works for one client’s case may not work for you. However, one of our guiding principles is that we believe it’s important to be proactive – not reactive. We actively challenge the government’s case and evidence so your situation can be resolved as quickly as possible. We also:

  • Will make immediate contact with government investigators and prosecutors assigned to your case so we can obtain the information they have and begin formulating your criminal defense strategy;
  • Ensure the correct legal standards and laws are being applied correctly to your case;
  • Work with you to craft a customized defense based on the nature of the evidence against you, the allegations made, and your goals;
  • Strive to protect your reputation and preserve your tangible and intangible assets.

Schedule a Confidential Case Evaluation With a Decisive Colorado Healthcare Fraud Defense Attorney

If you are being prosecuted by federal health care programs or private insurance companies. We provide only the best defense for health care providers. For your free and confidential case evaluation, please call the Colorado healthcare fraud defense lawyer at Oberheiden, P.C. at 888-680-1745 or request a free case evaluation through our website and let us help you today.

Oberheiden, P.C.
Compliance – Litigation – Defense
888-680-1745
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