Fresno Healthcare Fraud Defense Lawyer - Oberheiden, P.C.
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Fresno Healthcare Fraud Defense Lawyer

Our Fresno healthcare fraud defense attorney brings notable experience to representing providers, company executives, and healthcare entities in federal investigations. If your Fresno, CA, business or practice is under investigation, call 559-293-4777 for a free consultation.

Dr. Nick Oberheiden
Attorney Nick Oberheiden
Fresno Healthcare Defense
Team Lead envelope icon Contact Nick
Fresno address – by appointment only:
4781 E. Gettysburg Ave.
Fresno, CA 93726
559-293-4777

Most licensed medical professionals or company executives never think about being part of a federal investigation. You understood the burdens of complying with federal healthcare program billing regulations. You knew the conditions for registration with the Drug Enforcement Administration (DEA). You believed that your compliance efforts would be enough to allow you to avoid federal scrutiny.

Now that you have the government’s attention, what should you do? How can you prove that your business or practice has consistently remained fully compliant? Or, if there are issues, how can you address them to avoid civil or criminal prosecution? These are not easy questions to answer. To protect your healthcare business or practice, you will need experienced legal representation.

A Fresno healthcare fraud defense attorney in Oberheiden, P.C. represents individual and business clients in healthcare fraud investigations in Fresno, CA. Our team is composed entirely of senior defense attorneys and former federal prosecutors. They are highly experienced on both sides of federal investigations. If you are under investigation, you have options available. The best option for defending your business or practice requires knowledge only gained by handling thousands of federal cases.

In-Depth Knowledge and Strategic Insights for Healthcare Fraud Investigations in Fresno

Fresno Healthcare Fraud Defense Lawyer What does it mean to be under investigation for “healthcare fraud”? This is a surprisingly complicated question. There is not one single answer that will apply to all providers in all cases. Healthcare fraud is an umbrella term that covers a variety of different types of offenses. Federal healthcare fraud investigations often involve multiple civil and criminal laws.

When defending against a federal healthcare fraud investigation, one of the first steps is knowing what to defend against. In order to identify allegations against our clients, we intervene in the investigation. Our goal is to quickly collect some key pieces of information:

  • Which federal agency (or agencies) are handling the investigation?
  • Is the investigation civil or criminal in nature?
  • What triggered the investigation (e.g., automated comparative analysis of billing data or a “whistleblower” complaint)?
  • How long has the investigation been ongoing?
  • What types of information are the investigating agencies seeking to collect?

Once we have answers to these questions, we can determine the government’s allegations. Next, we execute a custom defense strategy. It will be based on the specific facts, laws, and regulations involved. In most cases, this means defending against allegations such as:

  • Billing for medically-unnecessary services
  • Billing for services not actually rendered to patients
  • Controlled Substances Act and DEA registration violations (e.g., prescription drug fraud)
  • Department of Labor (DOL) fraud
  • Falsifying patient records, prescriptions, physician certifications, and election statements
  • Medicare, Medicaid, and Tricare fraud
  • Stark Law violations (physician “self-referrals”)
  • Unlawful kickbacks and referral fees (Anti-Kickback Statute violations)

Prompt intervention and proactive defense are keys to avoiding costly prosecution and penalties. To start protecting yourself, your employees, and your business or practice in Fresno, call us 559-293-4777 now.

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)

What Practitioners and Business Owners in Fresno, CA, Need to Know about Federal Healthcare Fraud Investigations

1. The False Claims Act

The False Claims Act (FCA) applies to all healthcare providers and businesses billing federal benefit programs (i.e., Medicare, Medicaid, Tricare, and DOL) for reimbursement. It outlaws all “false and fraudulent” claims. Criminal penalties for intentional billing violations are also part of the FCA. These criminal penalties can include heavy fines and imprisonment.

Under the FCA, the standard for “fraud” is much lower than most people think. For civil penalties, it’s enough if you should have known about filing a claim that was non-compliant with billing regulations. Civil penalties include recoupments, assessments, fines, and program exclusion.

2. The Anti-Kickback Statute

The Anti-Kickback Statute (AKS) prohibits healthcare providers and other businesses from offering, paying, soliciting, or receiving any form of payment of services in exchange for a referral. This includes not only referral fees and other direct financial incentives, but also meals, entertainment, travel, and other in-kind gifts of any value.

There are a number of potential defenses to allegations under the AKS. One of the most effective strategies is to demonstrate that one of the statute’s “safe harbor” provisions applies.

3. The Stark Law

The Stark Law imposes civil penalties for physician self-referrals. A “self-referral” is any referral for Medicare or Medicaid reimbursed services provided to an entity where the referring physician has a financial connection. Referrals flowing in the opposite direction can trigger Stark Law liability for both parties.

The Stark Law’s prohibitions only apply to “designated health services.” These include:

  • Clinical laboratory services
  • Physical therapy services
  • Occupational therapy services
  • Outpatient speech-language pathology services
  • Radiology and certain other imaging services
  • Radiation therapy services and supplies
  • Durable medical equipment and supplies
  • Parenteral and enteral nutrients, equipment, and supplies
  • Prosthetics, orthotics, and prosthetic devices and supplies
  • Home health services
  • Outpatient prescription drugs
  • Inpatient and outpatient hospital services

4. The Controlled Substances Act

The CSA is one of the primary federal statutes used to prosecute those suspected of prescription drug-related offenses. Investigations under the CSA typically involve the DEA. They often include allegations carrying the potential for huge fines and long-term imprisonment.

5. The Federal Healthcare Fraud Statute

The healthcare fraud statute, 18 U.S.C. 1347, makes it a federal offense to “knowingly and willfully execute[], or attempt[] to execute, a scheme . . . to defraud any healthcare benefit program . . . [or to obtain] money or property owned by, or under the custody or control of, any healthcare benefit program [by false pretenses].” While most violations of 18 U.S.C. 1347 carry a maximum prison sentence of 10 years, violations resulting in serious bodily injury carry a maximum sentence of 20 years.

6. Conspiracy, Attempt, and Other Related Criminal Offenses

In criminal healthcare fraud investigations, providers can face charges under multiple federal statutes. A provider not found to have committed fraud, can still face fines and imprisonment for conspiracy or attempt. Other statutes that commonly come into play in federal healthcare fraud investigations include:

  • 18 U.S.C. 371 (criminal conspiracy)
  • 18 U.S.C. 1028A (identity theft)
  • 18 U.S.C. 1341 (mail fraud)
  • 18 U.S.C. 1343 (wire fraud)
  • 18 U.S.C. 1344 (bank fraud)
  • 18 U.S.C. 1357 (money laundering)
  • 21 U.S.C. 841 (distribution of controlled substances)
  • 26 U.S.C. 7206 (tax fraud)

7. Program Billing Regulations

As noted earlier, violations of healthcare program billing regulations can trigger liability under the FCA. Billing and coding violations can prompt Anti-Kickback Statute, Stark Law, and healthcare fraud statute probes as well. Providers accused of submitting multiple improper payment requests can face crippling financial penalties. We have experience in cases of thousands of alleged improper billings. Each claim carries the potential for tens of thousands of dollars in fines and assessments.

8. DOJ Mandates

While all forms of healthcare fraud can trigger federal investigations, the U.S. Department of Justice (DOJ) identifies prescription opioid diversion as a federal law enforcement priority. The DOJ has established multi-agency task forces in California and around the country. These task forces closely examine providers’ prescription practices. Any complaints or other evidence of opioid diversion will likely set-off a swift and thorough investigation.

Frequently Asked Questions

What are some examples of healthcare fraud?

 

Healthcare fraud refers to any falsified claim for reimbursement submitted to a federally funded program. Typically, healthcare providers render services or supplies to a patient, then submit a claim for payment. Given the number of claims filed, it may seem as though the federal government doesn’t keep a close eye on these submissions. However, that is not the case. There are several agencies that investigate healthcare fraud. Investigators can pick up on even small or isolated instances of misconduct. Below are some of the most common reasons the government chooses to pursue healthcare fraud charges:

  • 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
  • Overutilization of services or equipment

If you are involved in a healthcare audit or investigation, contact a Fresno federal healthcare fraud defense attorney right away.

What is the False Claims Act?

 

The False Claims Act (FCA) is a federal statute prohibiting the filing of a false or fraudulent claim for payment to a federal program. Some investigations under the FCA stem from government audits or inquiries. Others are the result of whistleblower allegations. Violations of the FCA can carry civil and criminal penalties, depending on the violation. If your practice is alleged to have run afoul of the FCA, speak to a Fresno, CA federal healthcare fraud defense attorney as soon as possible.

Who Investigates DEA Opioid Cases in Fresno, California?

 

Fresno is one of the hotspots of DEA opioid investigations. Federal prosecutors and DEA Diversion Investigators in California scrutinize physician offices to identify the main prescribers of:

  • Opioids,
  • Benzodiazepines,
  • Stimulants,
  • Sedatives, and
  • Muscle relaxants.

Involved in these operations are the:

  • Drug Enforcement Administration,
  • Department of Justice,
  • U.S. Attorney’s Office,
  • Office of Inspector General,
  • Department of Health and Human Services, and
  • Federal Bureau of Investigation.

5 Reasons to Choose the Fresno Healthcare Fraud Defense Lawyers at Oberheiden, P.C.

Why do healthcare providers in Fresno, CA, and nationwide trust Oberheiden, P.C.’s federal healthcare fraud defense team?

  • We have a long record of achieving favorable outcomes in healthcare fraud investigations.
  • We emphasize early resolution but never hesitate to fight for our clients at trial.
  • We rely on knowledge and insights from over 2,000 investigations and many trials.
  • We provide direct access to senior attorneys, and we do not employ junior associates or paralegals.
  • We fight strategically, aggressively, and relentlessly to secure favorable outcomes for our clients.

Contact Our Fresno Healthcare Fraud Defense Attorneys for a Free and Confidential Consultation

If you need legal representation for a federal healthcare fraud investigation in Fresno, contact our Fresno healthcare fraud defense lawyer now to schedule a free initial consultation. To discuss your case in confidence, call 559-293-4777 or tell us how to reach you online now.

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All website terms, conditions, and disclaimers apply to this information and are hereby fully incorporated. Specifically, this information has been prepared (1) for informational purposes only and does not constitute legal advice; (2) This information may constitute attorney advertising in some jurisdictions; (3) Merely reading this information does not create an attorney-client relationship; (4) Attorneys of Oberheiden, P.C., are not licensed in all states but are only licensed to practice in the states mentioned in their respective biographies. Nothing contained in here is meant to constitute the unauthorized practice of law or a suggestion of physical presence in the state; (5) Prior results do not guarantee similar outcomes in the future.
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