Fayetteville Healthcare Fraud Defense Lawyers

State and federal law enforcement agencies have increased their attention on healthcare providers in and around Fayetteville, Arkansas. If you have learned that you or your healthcare business is the target of an investigation, you need a team of experienced healthcare fraud defense lawyers on your side. Call the law office of Oberheiden P.C., today for a free and confidential consultation.

Healthcare providers across the country, including in Fayetteville, Arkansas, have seen a dramatic uptick in healthcare fraud investigations. Federal authorities are trying to crack down on fraud, mismanagement, and inefficiencies–particularly in government-funded healthcare programs like Medicaid and Medicare.

Our healthcare fraud defense attorneys represent all types of providers in Fayetteville. With extensive experience as both defense counsel for healthcare providers and former U.S. Department of Justice (DOJ) prosecutors, our lawyers are intimately familiar with the complex issues involved in these cases.

Types of Law Enforcement Actions That Healthcare Providers Can Face

Many healthcare providers believe that even if they make billing mistakes, so long as they did not intend to defraud a healthcare program or insurance company, they cannot be held accountable.

That is not the case.

A lack of intent only means that you cannot be held criminally liable for the conduct. Healthcare fraud cases, however, can be pursued in three different ways:

1. Criminally
2. Civilly
3. Administratively

Healthcare professionals can face civil or criminal charges depending on the evidence of intent. If there is evidence that you acted with the specific intent of defrauding a healthcare program, you will likely face a criminal case and prosecution. If convicted, you will:

• Have to pay back the amount you defrauded from the program
• Pay a criminal penalty
• Face the potential for a substantial amount of prison time
• Face other repercussions, like a suspension of your medical license or exclusion from a healthcare program, like Medicare or Medicaid

Even if there was no intent to commit fraud, though, law enforcement can still file a civil claim of healthcare fraud. While prison time is no longer on the table, you could still be facing a massive financial penalty, restitution, and, depending on the law that is being used to pursue your case, treble damages, or three times what you unlawfully obtained.

For relatively minor cases, law enforcement may pursue an administrative charge. This can result in fines and other financial penalties, as well as losing your license to practice medicine.

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)

Our Attorneys Defend Providers Against All Healthcare Fraud Allegations

Several federal laws apply in healthcare fraud cases, and most of them support criminal, civil, or administrative charges by federal law enforcement agencies including:

• Drug Enforcement Administration (DEA)
• Federal Bureau of Investigation (FBI)
• Department of Justice (DOJ)
• Office of Inspector General at the Health and Human Services Department (HHS-OIG)
• Centers for Medicare and Medicaid Services (CMS)

Allegations under any of these laws, be they criminal, civil, or just administrative, can lead to substantial penalties that imperil your future success in the healthcare field.

The False Claims Act

The federal civil False Claims Act (31 U.S.C. §§ 3729 – 3733) and its criminal cousin (18 U.S.C. § 287) forbid individuals and entities from filing fraudulent claims against the federal government. This includes claims for compensation from federal healthcare programs like:

• Medicare
• Medicaid
• Tricare

These statutes are a favorite of federal law enforcement officials. Civil penalties under the False Claims Act include treble damages, so the potential for a massive financial judgment is very high. It also serves as leverage over healthcare companies and pressures them to settle for steep civil penalties in order to avoid paying three times what they allegedly took in fraudulent conduct.

Common allegations in False Claims Act cases involving billings under government healthcare programs include:

• Double billing, where the healthcare provider sends the same bill multiple times
• Unpacking, where healthcare procedures that are normally billed together at a discount are separated and charged at full price
• Upcoding, where a more expensive procedure is billed than the one that was provided

In many cases, these allegations start with a whistleblower providing evidence of alleged misconduct to law enforcement agents. They often turn into debates over whether the healthcare procedure was medically necessary or not.

Healthcare Fraud and Conspiracy to Commit Healthcare Fraud

The general healthcare fraud statute at the federal level is 18 U.S.C. § 1347. The elements of this criminal offense are:

• Attempting or executing a scheme to defraud a healthcare program,
• Using false pretenses, representations, or promises to do so,
• Acting with the goal of obtaining money or any other property from that healthcare program, and
• Acting willfully or knowingly in doing so.

It covers many of the schemes that could support a False Claims Act allegation, above, such as unpacking or upcoding medical services. However, healthcare fraud cases under this particular statute are criminal offenses. Convictions carry substantial fines and up to 10 years in prison.

18 U.S.C. § 1349 supports conspiracy charges under this healthcare fraud law, as well. Even if you were not the one involved in the fraudulent conduct, if you agreed to partake in the fraud without committing an illegal act – such as by knowingly referring a patient to a healthcare provider so they could overcharge the patient’s healthcare program and give you a cut of the profits – you may face conspiracy charges.

Illegal Payments Under the Anti-Kickback Statute and Stark Law

Referring patients to a healthcare provider in which you have a financial interest can amount to a kickback. Kickbacks can be illegal multiple several federal laws:

• Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b))
• Stark Law (42 U.S.C. § 1395nn)
• Eliminating Kickbacks in Recovery Act (EKRA) (18 U.S.C. § 220)

Under the Anti-Kickback Statute, intentional violations can be felony criminal offenses that carry substantial prison sentences.

Under the Stark Law, meanwhile, no intent is necessary – unintentional or accidental conduct can lead to financial penalties. However, if there are signs that the violation was committed knowingly, the financial penalties under the Stark Law can increase and you could get excluded from Medicare or Medicaid.

Frequently Asked Questions About Healthcare Fraud and Oberheiden P.C.

Contact Our Fayettefille Healthcare Fraud Defense Lawyers

If you find yourself or your Fayetteville healthcare business under investigation for healthcare fraud, getting strong and experienced legal representation – and getting it fast – is essential. The next steps that you take can make or break your case. Mistakenly providing law enforcement with evidence that supports their worst suspicions can expose you and your company to substantial fines and possible long-term imprisonment.

Contact a Fayetteville healthcare fraud defense lawyer at Oberheiden P.C. today. Our firm stands ready to assist providers facing all allegations of healthcare fraud. Call (888) 680-1745 or contact us online now.