Denver Healthcare Fraud Defense Lawyers
Denver Healthcare Defense
Team Lead
Contact Nick1800 Wazee Suite 300
Denver, CO 80202
720-740-4203
Medical service providers in the Denver, CO area are at risk for federal healthcare fraud investigations. Many may need help from Denver healthcare fraud defense lawyers. Federal authorities at the U.S. Department of Justice (DOJ) and other federal agencies take strong measures to curb fraud in government health benefit programs. They target both organized crime syndicates and legitimate health practices. Federal agents rely heavily on data analytics to identify potential targets. When looking only at the numbers, however, it can be hard to tell a scam from a compliant healthcare practice.
If you are involved with a healthcare entity under federal investigation, take the situation very seriously. Your business or practice could face enormous financial liability. In addition, you may face exclusion from Medicare, Medicaid, Tricare, and other federal benefit programs. If you are personally implicated in alleged fraud, you could face substantial fines and a federal prison term. Plus, your license could be at risk even if the matter does not lead to civil or criminal charges. Contact Oberheiden, P.C. for a free consultation today.
Defending Against Healthcare Fraud Investigations and Charges in Denver, CO
Our Denver healthcare fraud defense attorneys bring notable experience to health providers in Denver, Colorado. The practice has successfully defended medical providers in civil cases and criminal prosecutions across the country. Several of our lawyers held high-level positions with the DOJ, the U.S. Attorney’s Office, and other legal departments within the federal government before entering private practice. They all have long and established records of obtaining favorable outcomes for clients.
“It is very clear to me that Nick Oberheiden has a deep understanding of health law issues. [He] has been instrumental in managing and resolving many difficult legal matters [and] is always relentlessly focused on the critical issues that matter most. Nick is very dedicated and . . . displays a high degree of professionalism. I would not hesitate in recommending Nick for the most important of legal matters.” – Satisfied Client
[“Excellent!”]
“I hired Nick Oberheiden and Oberheiden, P.C. to defend me in a criminal healthcare matter. From the first moment I met with Nick[,] my wife and I knew that he [would provide] the help I need[ed]. And yes, Nick got me out of trouble. No charges. Case Dismissed.” – Satisfied 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)
Common Allegations in Federal Healthcare Fraud Matters
In a Medicare fraud investigation, it is possible to face allegations under several federal laws. Prosecutors often pursue multiple charges against those suspected of defrauding the federal government. This includes charges under healthcare specific laws as well as those more general in nature. For any investigation, it is critical to discern the scope and nature of the government’s inquiry as soon as possible. The specific statute, or statutes, at issue will partially determine the defenses available to you.
Federal investigators and prosecutors commonly pursue fraud cases based on alleged violations of:
- False Claims Act. This is a federal law that bars the submission of “false and fraudulent” claims for payment by the government. In the healthcare context, it includes submitting inaccurate payment requests to federal health benefit programs. The following can potentially trigger such allegations leading to civil or criminal charges under the Act:
- Upcoding,
- Unbundling,
- Double-billing,
- Phantom billing,
- Billing for medically unneeded services, and
- Other billing violations.
- Anti-Kickback Statute. The Anti-Kickback Statute bans referrals involving the payment of fees, also called kickbacks or bribes, using funds received from a federal benefit program. While the law contains sweeping prohibitions, there are several statutory and regulatory safe harbors as well. Defending against illegal kickback allegations often means showing that a safe harbor applies.
- Stark Law. The Stark Law applies specifically to physicians and related healthcare entities. This includes entities both (i) in which physicians own a financial interest, and (ii) with which physicians have compensation-based relationships. Under the Stark Law, it is illegal for physicians to refer patients to related health entities unless a safe harbor applies. Violations can lead to civil penalties and False Claims Act liability.
- Controlled Substances Laws. Allegations of prescription drug fraud can lead to severe outcomes. Fines, a prison sentence, license revocation, and healthcare benefit program exclusion are some examples. Physicians, pharmacists, and others investigated for alleged activities such as:
- Prescribing narcotic medications to drug-dependent patients,
- Diverting prescription narcotics, and
- Prescribing narcotics without medical necessity.
In these scenarios, you need experienced legal counsel to intervene as soon as possible.
- Healthcare Benefit Program Laws and Regulations. The list of allegations that can trigger an investigation for federal healthcare fraud seems endless. Each Denver healthcare fraud defense attorney understands the laws and regulations for medical professionals who participate in federal healthcare programs. Our firm features former federal prosecutors and renown defense attorneys. We rely on their experience to protect our clients as thoroughly and cost-effectively as possible.
Q: If my billing manager mistakenly submitted an improper claim for payment to Medicare – can I be penalized?
Sadly, yes. In our experience, the vast majority of billing violations are the result of a simple human error. However, this does not necessarily insulate healthcare providers from liability. In many cases, proof of intent to commit fraud is not required to establish a violation. Providers must execute precisely planned defense strategies to mitigate the risk of honest mistakes leading to penalties.
Q: What are the differences between civil and criminal healthcare fraud investigations?
The primary difference between the two has to do with the potential penalties involved. In a civil case, the penalties are only financial in nature. They include recoupments, fines, treble damages, and program exclusion. A criminal case can lead to a convention and long-term imprisonment.
When you are under investigation, you may not know whether it is civil or criminal in nature. The False Claims Act and the Anti-Kickback Statute include both civil and criminal provisions. Plus, civil and criminal investigations can be similar in many respects. However, the nature of the allegations is one of the first things you need to know. When we represent a new client, one of our first priorities is to intervene in the investigation. We want to determine if our client is at risk for federal imprisonment.
Q: What are some examples of legal compensation arrangements under the Anti-Kickback Statute and the Stark Law?
The Anti-Kickback Statute and the Stark Law contain numerous safe harbor provisions to exempt specific types of transactions from bans against payments for patient referrals. These safe harbors tend to be highly complex. Explaining how a transaction or relationship qualifies for safe harbor protection requires a real knowledge of the law. Plus, the ability to effectively communicate with investigators and prosecutors is vital. Some categories of safe harbors we frequently use to protect our clients include:
- Bona-fide employment relationships
- Certain arrangements with hospitals and ambulatory surgery centers
- Discounts and group purchasing arrangements
- Exempt investment interests
- Fair market value compensation for healthcare services
- In-office ancillary services
- Isolated transactions
- Medical staff incidental benefits
- Personal service arrangements
- Referrals for specialty services
Q: What steps are involved in defending against a federal healthcare fraud investigation?
When under investigation for federal fraud, the first critical step is to intervene as soon as possible. Investigators and prosecutors need to know you are represented by counsel. We take steps to quickly gather information and begin working toward a favorable resolution. In broad terms, our approach to defending Denver-area clients involves:
- Early intervention in the investigation
- Establishing a dialogue with the investigators and prosecutors
- Conducting an internal assessment
- Developing and executing a tailored defense strategy
- Seeking to secure a favorable resolution before charges are filed
Speak with A Diligent Denver Healthcare Fraud Defense Lawyer in Confidence at Oberheiden, P.C.
If you are facing a federal fraud investigation in Denver, Colorado, we encourage you to contact us promptly for a free initial consultation. To speak with a Denver healthcare fraud defense attorney about your investigation, please call 720-740-4203 or inquire online now.
