Dade County Healthcare Fraud Defense Lawyers
If federal agents are investigating you or your healthcare practice in Florida, you need experienced Dade County healthcare fraud defense lawyers at Oberheiden, P.C., on your side.
Dade County Healthcare Fraud Defense Team Lead
Former Deputy Chief, Appellate Division
Any provider, corporate officer or owner in a healthcare business in Dade County, Florida – whether as a provider or a corporate officer or owner in a healthcare business should know that federal agents are currently targeting the greater Miami area – and have been for several years. Why Dade County? The area has one of the largest populations of Medicare and Medicaid recipients in the country. It is one of the largest and fastest-growing cities in the southern United States. Federal agents from the Department of Justice (DOJ) and the Department of Health and Human Services’ Office of Inspector General (DHHS – OIG) invest a great amount to investigate doctors and other healthcare providers suspected of fraud. These agencies work closely with officers from the DEA, FBI, IRS, and even state law enforcement agencies. They investigate Dade County healthcare providers for:
- Opioid diversion,
- Pharmaceutical fraud,
- Tax fraud,
- Mail fraud,
- Wire fraud,
- Identity theft, and more.
Oberheiden, P.C. is a federal criminal defense law firm with a national presence. Combined, our attorneys have spent over 100 years in criminal defense. Several of our Dade County healthcare fraud defense attorneys are former federal prosecutors who worked in the Department of Justice or other agencies. In the majority of cases, we’ve been able to avoid criminal charges against healthcare providers. Our attorneys can’t promise a particular result. But, we will always fight for the optimal outcome. That means keeping our clients licensed, in practice, in business, out of prison, and free from crippling criminal or civil fines whenever possible. More often than not, we’ve met those goals for the people and businesses we serve. We offer an initial free consultation to find our what you may be facing in your case.
What Is Healthcare Fraud?
There are many kinds of healthcare fraud. Some common examples include:
- Billing fraud (phantom billing, upcoding, false claims, etc.)
- Department of Labor (DOL) fraud;
- Anti-Kickback Statute violations;
- Stark Law violations (physician self-referral);
- Prescription drug fraud and other Controlled Substances Act (CSA) / DEA registration violations;
- Billing for services that are not medically necessary;
- Billing for services never provided;
- Falsifying patient records, prescriptions, physician certifications, or election statements.
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)
Federal Healthcare Statutes and Other Sources of Law You Need to Know
1. The False Claims Act
It is absolutely critical that healthcare providers understand the federal False Claims Act (FCA) and fully appreciate its expansive scope. The FCA makes it a criminal offense to send “false or fraudulent” claims to a federal healthcare program (e.g., Medicare, Medicaid, Tricare, DOL, etc.). The penalty for a false claim can range from prison to enormous civil or criminal fines. The fines alone can add up to tens of thousands of dollars per false claim submitted. Those convicted also face potential program exclusion. The FCA also provides the strongest whistleblower and qui tam provisions in the federal healthcare system. These provisions incentivize others to bring civil claims against healthcare providers. Such claims can quickly trigger criminal inquiries. Learn more about the False Claims Act.
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) provides restrictions on healthcare providers’ activity in certain marketing techniques that would be normal in many other industries. Under the AKS, it is illegal to offer, pay, solicit, or receive remuneration in exchange for patient referrals. Prosecutors must be able to prove that the violation was intentional in order to convict. “Remuneration,” meanwhile, is broadly defined. An AKS investigation can be civil or criminal in nature. Our Dade County healthcare fraud defense attorney can help in either event.
3. The Stark Law
The Stark Law pertains precisely to “physician self-referrals”. Self-referrals are illegal under this law and may lead to major civil penalties. We urge any Dade County physicians treating Medicare or Medicaid recipients and who have concerns about a self-referral investigation to contact our office as soon as possible.
4. The Federal Healthcare Fraud Statute
It is not uncommon for federal prosecutors to seek charges under as many different federal statutes as possible (often with multiple counts of each). One especially common statute is 18 U.S.C. 1347, also known as the “healthcare fraud statute.” It reads (in part): (a) “Whoever knowingly and willfully executes, or attempts to execute, a scheme or artifice – (1) to defraud any healthcare benefit program; or (2) 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, in connection with the delivery of or payment for healthcare benefits, items, or services, shall be fined under this title or imprisoned not more than 10 years, or both…”
5. Other Fraud Statutes
Allegations of healthcare fraud lend themselves to other, closely related fraud charges. Thus, these and other charges may also appear on federal indictments of healthcare providers in Miami/Dade County:
- Mail fraud
- Wire fraud
- Bank fraud
- Money laundering
- Tax fraud
- Forgery
- Making false statements
- Conspiracy
- Wrongful use of identifying health information
It’s in your best interest to hire a law firm with experience in a wide range of federal fraud allegations in addition to healthcare fraud.
6. Program Billing Regulations
Federal benefits programs often impose their own internal billing regulations. Violating these regulations, even unintentionally, may result in prosecution. Most fraud charges require proof of intent but, prosecution for violating program billing regulations typically doesn’t. Healthcare providers in Dade County must maintain an active compliance program to mitigate the risk of unwittingly violating a federal billing regulation.
7. DOJ Mandates
The DOJ routinely issues public announcements identifying new law enforcement priorities and task forces. While the mandates are not “law” per se, they do affect when, where, how, and on what grounds federal agents can arrest providers. The DOJ intensified its focus on opioid fraud and abuse by launching the Opioid Fraud and Abuse Detection Unit and the Prescription Interdiction & Litigation (PIL) Task Force.
8. The Controlled Substances Act (CSA)
The Controlled Substances Act is one of the primary federal statutes used to prosecute providers suspected of pharmaceutical fraud. Examples of this fraud include writing prescriptions for unneeded medications. In addition, fraud is offering prescriptions or medications in exchange for cash, sex, or other incentives. The CSA is used to prosecute healthcare providers including:
- Doctors,
- Nurses,
- Pharmacists,
- Business owners, and others.
5 Reasons to Trust Oberheiden, P.C., as Dade County Federal Healthcare Fraud Defense Attorneys
Here are five reasons why healthcare professionals and business entities should choose legal counsel from an Oberheiden, P.C. Dade County healthcare fraud defense attorney:
- Our Extensive Experience in Healthcare Fraud Investigations – Healthcare fraud cases are usually complex and the stakes are incredibly high. You should choose a defense firm with years of hands-on experience at every stage of a healthcare criminal case. When you hire Oberheiden, P.C., the only Dade County healthcare fraud defense lawyer working on your case will be a senior-level lawyer with extensive experience.
- Our Record of Avoiding Charges – Every case is unique, and we can’t guarantee specific results, but we are proud of our record. At Oberheiden, P.C., each member of our team has avoided criminal charges for the majority of our clients. Avoiding charges is the most effective way to resolve a criminal investigation. We do everything we can to achieve that goal in every case.
- Our Experience on Both Sides – Several of the lawyers at Oberheiden, P.C., are former federal prosecutors. So much of our defense work involves communicating and negotiating with the federal government. Several of our attorneys used to work for the federal government. Their experience brings a valuable perspective to our negotiations and defense strategies.
- Our Focus on Federal Healthcare Fraud Defense – Our extensive experience in this area means we can provide an aggressive defense in any healthcare criminal matter. We represent:
- Doctors,
- Pharmacists,
- Physician’s groups,
- Ambulance providers,
- Medical clinics,
- Hospitals,
- Hospices,
- Medical labs,
- Mobile labs,
- Diagnostic companies, plus many others.
- Our Aggressive Defense Strategies – When the stakes are high, you need attorneys who will fight for you with passion. We adopt an assertive approach for every client. Our team believes this attitude is responsible for our long record of positive results.
Frequently Asked Questions
What is the difference between the Anti-Kickback Statute and the Stark Law?
The AKS and the Stark Law place significant limits on a provider’s ability to receive referral payments. However, the two laws are very distinct in several respects. The AKS is a criminal law forbidding providers from receiving or paying anything of value for referring a patient covered by a federal program. However, the Stark Law applies to all patients, whether or not they receive government benefits. The Stark Law limits situations where a provider may refer patients to another practice in which the referring party receives financial gain. Although both statutes can result in significant civil penalties, only the AKS carries possible criminal sanctions. If you’re suspected of healthcare fraud, speak to an experienced Dade County, FL federal healthcare fraud defense attorney today.
What is the Eliminating Kickbacks in Recovery Act?
To reduce the number of people profiting from referring patients, Congress passed the Eliminating Kickbacks in Recovery Act (EKRA) in 2018. EKRA prohibits accepting or paying kickbacks for referrals to recovery homes, clinical treatment facilities, or labs. While EKRA focuses on payments made by the above, the law’s reach extends beyond. In fact, any healthcare provider who refers patients to these facilities may be breaking the law. If you operate or refer patients to such practices, it’s critical to discuss the referral process with an experienced Dade County federal healthcare fraud defense attorney.
What are the most common examples of Medicare Fraud?
Medicare fraud involves any fraudulent or false claim submitted to the Medicare program for payment. It also includes overcharging the government for services actually provided to the patient. Some of the most common examples of Medicare fraud include:
- Billing for services that were not performed;
- Billing for services that were not medically necessary;
- Billing for supplies or equipment that were never ordered;
- Billing for supplies or equipment that were not medically necessary;
- Certification for services or supplies that were not medically necessary;
- Double billing, up-coding, and inflating bills; and
- Overutilization of services or equipment.
Healthcare fraud laws also prohibit certain referral relationships between practitioners. Under the Anti-Kickback Statute, providers cannot receive anything of value for referring a patient whose medical expenses are paid by Medicare. If you find yourself in a healthcare fraud case, speak to a respected Florida federal healthcare fraud defense attorney as soon as possible.
Discuss Your Federal Healthcare Fraud Investigation in Confidence
If your Dade County healthcare practice or company is being targeted by federal healthcare fraud investigators, we urge you to contact a proven Dade County healthcare fraud defense lawyer for a free and confidential consultation. To speak with a member of our federal defense team, right away, call 305-694-5300 or inquire online as soon as possible.
