Columbus Healthcare Fraud Defense Lawyer
Proven Defense Attorneys for Columbus Healthcare Fraud Investigations and Charges
Columbus Healthcare Defense
Team Lead
Contact Nick175 South 3rd Street Suite 200
Columbus, OH, 43215
888-680-1745
Following a national takedown involving two providers in Central Ohio last year, federal prosecutors continue to aggressively target healthcare providers in Columbus. If your business or practice is under investigation, our Columbus healthcare fraud defense lawyers can help protect you against serious penalties, including crippling fines and incarceration.
In July 2017, the U.S. Department of Justice (DOJ) announced the nation’s largest-ever healthcare fraud takedown. Involving law enforcement efforts in 41 federal districts, the case ensnared 412 defendants, including 115 “doctors, nurses, and other licensed medical professionals” who were allegedly part of a $1.3 billion fraud scheme that involved improper treatment and prescription of opioid medications.
Four of these defendants were based in Central Ohio. These individuals, who are collectively accused of defrauding Medicare and Medicaid of more than $5 million, were charged with crimes carrying the potential for millions of dollars in fines and recoupments, and decades of federal imprisonment. According to a Special Agent in Charge (SAC) with the Department of Health and Human Services’ Office of Inspector General (OIG):
“The charges announced today should send a strong message to criminals that theft from vital healthcare programs will not be tolerated. . . . The OIG and our law enforcement partners will continue to be vigilant in our efforts to protect taxpayer dollars that are intended to aid our most vulnerable citizens.”
In other words, healthcare providers in Columbus have cause for concern when it comes to being at risk for federal investigation and prosecution. Now that government investigations have led to local indictments, medical providers throughout Central Ohio may face enhanced scrutiny as the DOJ, OIG, Medicare Fraud Strike Force, and other federal authorities continue their fight against healthcare fraud and abuse.
Former DOJ Prosecutors Representing Healthcare Providers in Columbus, OH
Oberheiden, P.C. is a healthcare fraud defense law firm We represent providers in Medicare, Medicaid, Tricare, and other healthcare benefit program fraud investigations. Our Columbus attorneys represent local physicians, pharmacists, and other providers in compliance and enforcement matters. We have a a history of successfully defending all types of healthcare providers across the nation. Our team includes highly experienced former prosecutors with the DOJ. We take a team approach to defending our clients. This ensures each one has the weight of our attorneys’ collective experience on their side.
“It is very clear to me that Nick Oberheiden has a deep understanding of health law issues. Nick has been instrumental in managing and resolving many difficult legal matters. He is always relentlessly focused on the critical issues that matter most. Nick is very dedicated and available and always displays a high degree of professionalism. I would not hesitate in recommending Nick for the most important of legal matters.” – Healthcare Provider, Firm Client
“We have never dealt with legal counsel who is so down to earth and compassionate toward his clients. [Dr. Nick Oberheiden] has a level of compassion and dedication that one would only expect from a family member. He is responsive and has even worked with us on weekends . . . . In a situation where we felt like there was little hope, this gentleman provided a bright light at the end of a dark tunnel. He has a heart for what he does that we don’t often see in today’s legal profession.” – Healthcare Provider, Firm Client
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)
Over 100 Years of Collective Experience in Healthcare Fraud Matters
With these years of experience, we’ve handled well over 2,000 cases. The cases range from administrative coding errors to intentional insurance fraud. We aim for the goal of minimizing the effects of your federal healthcare fraud investigation. A Columbus healthcare fraud defense attorney represents licensed professionals, medical practices, healthcare facilities, and other individuals and organizations as Ohio clients, and nationwide in a range of legal matters.
1. Billing and Coding Violations
Allegations of billing and coding violations involving federal healthcare benefit programs are increasingly common. This is as federal authorities enhance their reliance on data analytics to identify targets. Frequently, investigations focus on billing practices that appear to raise concerns when viewed out of context. In reality, they simply reflect the nuances of practicing in a particular location. Some of the most common alleged billing fraud and coding violations include:
- Billing for non-allowable costs, such as operational expenses. Or, ineligible services like those rendered by an unlicensed or excluded provider;
- Billing under outdated Medicare, Medicaid, Tricare, or other program billing regulations;
- Double-billing a healthcare benefit program, multiple benefit programs, or a benefit program and a private insurer;
- Unbundling related services in order to bill at a higher rate;
- Up-coding services to bill at a higher rate than that which should be charged;
- Using the wrong billing code when submitting a claim to Medicare, Medicaid, Tricare, or another healthcare benefit program.
2. Kickbacks and Referral Fees
Kickbacks and referral fees are very common issues involved in federal investigations. Under the Anti-Kickback Statute, it’s a federal offense to “knowingly and willfully” offer, pay, solicit, or receive remuneration, directly or indirectly, in order to induce business that is reimbursable under any federal healthcare program. Proof of actual knowledge is not required. Plus, you do not have to consummate a transaction in order to trigger liability under the Anti-Kickback Statute.
3. Physician Self-Referrals
The Stark Law, or physician self-referral statute, imposes strict liability for physicians who make referrals for program-reimbursed “designated health services” to entities with which they have certain types of financial relationships. “Designated health services” under the Stark Law include:
- Clinical laboratory services,
- DME and medical supplies,
- Home health services,
- Imaging,
- Inpatient and outpatient hospital services,
- Outpatient pathology,
- Outpatient prescriptions,
- Parenteral and enteral nutrients, equipment, and supplies,
- Physical therapy,
- Prosthetics, orthotics, and related supplies,
- Radiology and radiological therapy.
Financial relationships that can trigger liability under the Stark Law include:
- Direct compensation arrangements,
- Direct investment,
- Indirect investment or compensation arrangements,
- Company or practice ownership,
Like the Anti-Kickback Statute, the Stark Law includes a number of safe harbors and exceptions. Successfully defending against allegations of unlawful physician self-referrals means convincing federal prosecutors that one of these special statutory or regulatory protections applies. It takes an experienced Columbus healthcare fraud defense attorney to counter such accusations.
4. False and Fraudulent Claims
The False Claims Act (FCA) is the primary source of legal authority involved in most healthcare fraud cases. Even in situations where physicians and other providers face liability under the Anti-Kickback Statute or Stark Law, they may also face FCA liability. The False Claims Act allows both criminal and civil penalties including:
- Civil or criminal fines,
- Recoupment of overbilled amounts,
- Treble damages (three times the government’s actual losses),
- Loss of federal healthcare benefit program eligibility (program exclusion),
- Five years of federal imprisonment for each individual offense,
5. Billing for Medically-Unnecessary Services, Supplies, or Equipment
Federal healthcare benefit programs only provide payment for services program administrators have approved. If a service is considered not medically necessary, it is ineligible for payment. Plus, any attempt to claim reimbursement can trigger allegations of healthcare fraud. Some of the most common types of issues involved in so-called “medical necessity” investigations include:
- Providing treatment outside of program guidelines or beyond the program-approved length of stay;
- Providing necessary services, supplies, or equipment in connection with non-necessary services, such as cosmetic surgery;
- Using higher-cost treatment options where lower-cost (and potentially lower-quality) treatment options are available;
6. Billing for Services, Supplies, or Equipment Not Provided
Allegations of billing for services, supplies, or equipment not provided can be based on evidence of intentional fraud. These investigations, however, frequently center around issues of adequate documentation. If your business or practice has been accused of “phantom billing,” it will be important to get to the bottom of the issue. This will allow you to tailor your defense to the specific issue at hand.
7. Prescription Drug Fraud
Prescription drug fraud is an area of enforcement that has become more active. It’s the result of the DOJ’s decision to prosecute providers to tackle opioid abuse and dependence. Pharmacies, compound pharmacies, physician-owned practices, clinics, hospitals, and other providers become targets of prescription fraud with increasing frequency in situations involving allegations of:
- Dispensing more medication than was prescribed;
- Drug shorting and refill schemes;
- Falsifying and forging prescriptions;
- Prescribing medications that are not medically necessary (including falsifying patient records and selling fraudulent prescriptions);
- Prescribing medications without an in-person exam;
- Prescription drug diversion.
8. Falsifying Patient Records and Inaccurately Reporting Test Results
Other types of fraud can involve allegations of falsifying patient records. Thorough documentation and effective communication are critical. Preventing charges being brought is often a matter of showing why the assumptions of investigators are mistaken.
9. Fraudulent Physician Certifications for Home Health and Hospice Care
Successfully defending against investigations targeting home health and hospice care can require similar skills. The physician certification process is necessary for providing program-reimbursed services. Therefore, it’s often an initial source of suspicion for federal authorities seeking to target home health and hospice providers. Common allegations against home health agencies, hospices, and certifying physicians include:
- Forging physician certifications;
- Paying or receiving kickbacks or referral fees in connection with physician certifications;
- Relying on a physician other than the patient’s primary care physician to provide a certification;
- Supplying and relying upon false and fraudulent physician certifications.
10. Fraudulent Election Statements for Hospice Care
Home health and hospice care providers are often scrutinized for their election statement practices as well. These providers must obtain valid election statements from their patients prior to beginning treatment. Failure to obtain valid election statements can lead to charges under the False Claims Act and other federal laws. It is also vital to maintain adequate documentation of patients’ election statements.
Q&A: Defending Against Healthcare Fraud Allegations in Columbus, OH
Q: Which federal agencies can investigate and prosecute healthcare providers suspected of engaging in fraudulent billing practices?
Numerous federal agencies and task forces are involved in the government’s fight against healthcare fraud. In cases involving Medicaid, you will want an Ohio Medicaid fraud lawyer because state authorities will often be involved, such as the Ohio Medicaid Fraud Control Unit (MFCU). At Oberheiden, P.C., our Columbus healthcare fraud defense attorneys represent clients in cases involving:
- Centers for Medicare and Medicaid Services (CMS),
- Department of Defense (DOD),
- Department of Health and Human Services’ Office of Inspector General (OIG),
- Department of Justice (DOJ),
- Department of Labor (DOL),
- Drug Enforcement Administration (DEA),
- Federal Bureau of Investigation (FBI),
- Medicare Fraud Strike Force,
- U.S. Attorney’s Office.
If you or anyone in your practice is contacted by an agent or prosecutor from one of these agencies, it is important to contact a healthcare fraud defense lawyer promptly. At this point, you cannot afford to make mistakes, and you need to get in front of the investigation so you are able to execute a defense strategy that is tailored to the specific focus of the government’s inquiry. To learn more about your situation, we encourage you to read: 10 Things To Do When You Are Under Healthcare Fraud Investigation.
Q: Can I really go to prison for overbilling Medicare, Medicaid, or Tricare?
Yes! If federal prosecutors believe they have evidence of intent to commit fraud, they can pursue criminal charges under the False Claims Act. A health care fraud conviction can lead to a federal prison sentence, with potential sentences of up to five years for each count of the alleged violation. Combined with charges for criminal conspiracy, mail fraud, wire fraud, and various “add-on” offenses, it’s not unusual for decades of prison time to be on the table in cases of intentional fraud.
Q: What are some potential defenses to healthcare fraud?
To avoid severe penalties in a criminal case, including federal imprisonment, one of the most important lines of criminal defense is challenging the government’s evidence of intent. If prosecutors can’t prove intent, then they can’t obtain a criminal conviction. Depending on the details involved in your investigation, other potential defenses include:
- Assertion of safe harbors and exceptions under the Anti-Kickback Statute or the Stark Law;
- Assertion of your Constitutional Rights (such as your right to be free from unreasonable searches and seizures);
- Challenging the government’s evidence of each element of the alleged offense;
- Demonstrating that any alleged overbillings were appropriate under the then-current program billing regulations;
- Demonstrating that any alleged violations, or billing errors were the result of honest human error and not committed knowingly or intentionally.
Why Choose Oberheiden, P.C. in Columbus, OH?
1. Our Healthcare Fraud Experience
We aren’t just healthcare lawyers or defense lawyers. A Columbus healthcare fraud defense lawyer with extensive experience in defending those who deliver medical services, is waiting for your call. Our healthcare fraud defense attorneys are highly experienced specifically in dealing with fraud investigations.
2. Our DOJ Background
Several of our experienced attorneys began their careers as healthcare fraud prosecutors with the DOJ. As a result, we know healthcare fraud investigations from the inside out. We are able to use this experience to execute custom defense strategies for our clients.
3. Our Consistent Results
We have resolved a remarkable percentage of our clients’ cases without federal indictments. To date, not a single client of Oberheiden, P.C. has faced civil or criminal liability under the False Claims Act.
4. Our Team Approach
With our unique team approach, each of our attorneys plays a role in every case we handle. We leave no stone unturned and ensure that we provide our clients with the best possible legal representation.
5. Our Commitment to Success
We resolve most of our clients’ cases during the investigative process. However, when necessary, we do not hesitate to fight for our clients’ freedom at trial.
Schedule a Free Case Assessment at Oberheiden, P.C.
If you are facing a healthcare fraud investigation in Columbus, OH, we encourage you to contact us promptly for a free case evaluation. To speak with a Columbus healthcare fraud defense lawyer on our fraud defense team in confidence, please call 888-680-1745 or inquire online now.
