Lakeland Healthcare Fraud Defense Lawyer
Lakeland Healthcare Fraud Defense Team Lead
Former Deputy Chief, Appellate Division
We proudly offer our services to clients in Lakeland as well as throughout Florida. If you’re under investigation for healthcare fraud in Lakeland, Florida or the surrounding areas, call us to speak with our Lakeland healthcare fraud defense lawyers. Calls are free and confidential. We also offer a free initial consultation to evaluate the legal options available to potential clients.
Healthcare providers, entities, and businesses in Lakeland, Florida, and the surrounding areas are at risk of being accused of healthcare fraud. Oberheiden, P.C. is here to help. Our attorneys have substantial experience in healthcare fraud defense, Medicare and Tricare audits, protection of assets, compliance programs, jury trials, fraud allegation defense, qui tam defense, OIG and grand jury subpoenas,
criminal defense, and internal investigations.
Lakeland, Florida Is Diligently Watched for Healthcare Fraud
Lakeland, Florida is one of nine areas in the United States that is closely monitored for healthcare fraud by the Medicare Fraud Strike Force. This is a federal investigative body that consists of prosecutors and investigators from several federal agencies. Such scrutiny is based on the number of citizens who rely on a federal healthcare program. Since there are more beneficiaries in the area, there are more claims filed with the federal government for payment. The government believes this large number of claims means an increase in healthcare fraud, which can be classified as either a state-level crime or a federal offense, emphasizing the serious legal implications. In FY 2022, the Department of Justice (DOJ) opened more than 809 new criminal health care fraud investigations. Federal prosecutors filed criminal charges in over 419 cases involving at least 680 defendants. More than 477 defendants were convicted of health care fraud related crimes during the year. Also, in FY 2022, DOJ opened more than 774 new civil health care fraud investigations and had over 1,288 civil health care fraud matters pending at the end of the fiscal year. OIG, HHS
What Is Federal Healthcare Fraud?
Medicare fraud is a violation of federal law. It often results in civil and criminal penalties. Medicare fraud occurs when one or more claims are filed with a federal healthcare program for reimbursement. The claim includes an inaccuracy. However, Medicare fraud also includes Medicaid, Tricare, and federal workers’ compensation. Medicare fraud becomes a federal offense when an individual knowingly and willfully executes a fraudulent scheme. Medicare fraud allegations mean that the government is investigating you for violating at least one of the following laws or statutes:
- The Anti-Kickback Statute. Federal law bans offering, paying, soliciting, and receiving referral fees or other forms of payment for federally funded medical services and equipment. Like the False Claims Act, the AKS includes both civil and criminal justice system enforcement provisions. The AKS’s broad prohibitions are subject to several statutory safe harbors. These safe harbors provide complete defenses to liability in many cases.
- Stark Law. The Stark Law prohibits physicians from referring others to entities in which they or a close family member has a potential financial gain. These physician “self-referrals” can lead to civil penalties, including fines, recoupments, and treble damages. The Stark Law includes various safe harbor provisions. Our Lakeland healthcare fraud defense attorneys are skilled at using these safe harbors to protect clients.
- False Claims Act. The False Claims Act (FCA)bars filing any “false or fraudulent” claim for payment by a federal healthcare benefit program. If an investigation reveals evidence of intent, FCA charges can be civil or criminal in nature. Potential stiff penalties include civil monetary judgments, criminal fines, and federal imprisonment.
- Prescription Fraud. The federal government pays special attention to healthcare practices issuing an unusually high number of narcotic prescriptions. If you are suspected of running a “pill mill,” you are at a high risk of investigation for insurance fraud and for violating DEA dispensing rules.
- Billing Fraud. One of the most common occurrences of billing fraud is upcoding. This occurs when a higher, and more costly, code is used on claims made to federal healthcare programs. The federal government also investigates:
- Allegations of phantom billing (services not provided),
- Ghost patients (patients who do not exist), and
- Billing for medically unnecessary services or equipment.
- Certification Errors. The home healthcare and hospice industry is one the government chooses to maintain a close eye on. The most common accusations include fraudulent certification for home healthcare and hospice care.
Oberheiden, P.C.’s main objective is to help clients avoid criminal charges. If you’re being investigated for federal healthcare fraud in Lakeland, Florida, or the surrounding area, call our Lakeland healthcare fraud defense attorneys right away. The call is free and confidential.
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)
What Are the Civil and Criminal Penalties of Healthcare Fraud?
Federal healthcare fraud carriescarry civil and criminal penalties. If you’re tried in civil court, you could be ordered to repay the federal claims, lose the ability to be reimbursed for future claims, and be barred from participating in federal healthcare programs. If you’re tried in criminal court, you could end up with a criminal record, and fines that cost you hundreds of thousands of dollars. You could even be sentenced to federal prison for:
- Up to 10 years for each count of healthcare fraud
- Up to 20 years for each count of fraud that resulted in serious bodily injury
- Life sentence if the healthcare fraud resulted in death
Understanding the potential consequences of healthcare fraud convictions is crucial. One of the most common questions that we’re asked is, what is the worst-case scenario when it comes to healthcare fraud? Whether you’ll face criminal charges or a prison sentence depends on several factors. These are: the severity of injury suffered by a patient, whether the prosecutor sees an advantage in pursuing criminal charges, and the reason the federal government began the case. If you’re under investigation for healthcare fraud, contact Oberheiden, P.C. Your initial call is confidential and free.
Is the Investigation Against You Civil or Criminal?
Healthcare fraud investigations in Lakeland, Florida can be civil or criminal. Cases can start as civil and then become criminal as the case progresses. Being contacted by a prosecutor is not an indicator that the investigation is criminal. All federal agencies with prosecutors have both a civil and a criminal branch. That’s why you cannot use contact by a federal court prosecutor as an indicator. Rather, signs of a criminal investigation may include:
- Search warrants,
- Seizure warrants,
- Arrest warrants,
- Target letters,
- Contact from a federal criminal prosecutor,
- Involvement from the IRS, or
- Receipt of a grand jury subpoena.
Frequently Asked Questions
What is the difference between the Anti-Kickback Statute and the Stark Law?
Both the federal Anti-Kickback Statute (AKS) and the Stark Law limit a medical provider’s ability to refer patients in certain situations. The AKS deals with patients whose medical expenses are paid by a federally funded program. Specifically, the AKS forbids any referral fee, monetary or otherwise. The Stark Law bars most cases of physician self-referrals. This is where a provider refers a patient to another provider in whom the referring physician has an economic interest. The Stark Law applies to any patient, not necessarily one who is covered under a federal program. The other significant difference between the two laws is that the AKS is a criminal law statute, carrying a maximum penalty of five years in prison and a fine of up to $25,000. The Stark Law is a civil statute, which carries a maximum penalty of $15,000 per violation. If you are under investigation for any type of healthcare fraud, it is vital to contact an experienced Lakeland healthcare fraud defense attorney today.
What is Medicare fraud?
Medicare fraud is an umbrella term used to describe any situation where a healthcare provider, medical device manufacturer, or other related party submits false information, a false, or a fraudulent claim to Medicare for payment. The following are some of the most common examples of Medicare fraud:
- Billing for services that were not medically necessary;
- Billing for supplies or equipment that were never ordered;
- Billing for services that were not performed;
- 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.
Medicare fraud is the most common type of healthcare fraud. Federal agencies are always on the lookout for providers who submit false, excessive, or unauthorized claims for payment. If your business or practice is suspected of Medicare fraud, speak to a respected Lakeland healthcare fraud defense attorney today. Additionally, the increasing regulation and investigative efforts by government bodies in relation to Medicaid fraud highlight the stiff penalties and complexities involved in healthcare fraud enforcement.
What can I do to avoid healthcare fraud charges?
Taking a proactive approach to compliance is by far the best way to avoid healthcare fraud charges. Develop a compliance strategy that provides employees with the necessary guidance so their actions comply with applicable laws and regulations. Such an approach also shows management’s commitment to compliance. Such a program is one of the factors the federal government uses to determine how to proceed when a potential violation is found. A Lakeland federal healthcare fraud defense lawyer can identify potential areas of non-compliance and work with you to address any issues. However, if the government has already begun to look into your practice, it is essential to meet with an attorney to develop a defense strategy. Building a strong defense is crucial to effectively challenge evidence and formulate strategies tailored to your specific circumstances.
Using Healthcare Fraud Defenses
Oberheiden, P.C. is a healthcare fraud defense law firm. We provide legal defenses for individual healthcare providers, entire healthcare systems, and businesses in Lakeland, Florida and the surrounding areas. We’ve provided help in hundreds of cases. Several members of our team have experience as former healthcare auditors and as healthcare fraud prosecutors with both the Department of Justice and the Medicare Fraud Strike Force. We use this experience to develop strategic defenses for each of our clients.
Immediately reaching out to the federal government. The main priority of our firm is to help our clients avoid criminal charges. Once retained, we immediately contact the federal government. This shortens the amount of time that the federal government has to investigate you without interruption. If the government has a long period of time to investigate you, you could face charges. Our goal is to get answers to the most important questions within hours:
- What is the investigation about?
- What is the purpose of it?
- How long will the investigation take?
- What is the most likely outcome?
Showing our clients did not commit a crime. The federal government must meet a high burden of proof to show you committed a crime and acted with criminal intent. We evaluate the evidence given by the federal government to determine if they are able to meet that goal. Often, the federal government will point to billing inaccuracies to say that you committed a crime. Yet, we’ve found that these inaccuracies occur not because of fraud, but because of a mistake. While these mistakes should certainly be addressed and corrected, they shouldn’t cause a criminal conviction. The most common mistakes causing these allegations include:
- The use of unqualified workers,
- Delegation errors,
- Outsourcing errors,
- Lack of oversight,
- Insufficient supervision, and
- Frequently changing laws and rules of healthcare billing.
The use of strategic defenses for each client. Oberheiden, P.C. analyzes each case in order to design the right strategic defenses. This may include using statutory loopholes and exceptions. For example, the Stark Law involves medical necessity certifications. Where applicable, we will point to these exceptions to either mitigate or entirely resolve a healthcare fraud case.
Protecting your professional reputation. An allegation of healthcare fraud can damage your professional reputation. Oberheiden, P.C. will work to protect your good name. We look for opportunities to correct misinformation. We also address slanderous comments made by the media.
If you’re in Lakeland, Florida or the surrounding areas and you’re being investigated for healthcare fraud, call Oberheiden, P.C. now to speak to our Lakeland healthcare fraud defense lawyers. The call is free and confidential.
Our Track Record
The commitment of Oberheiden, P.C. is to avoid criminal charges and to shield our client’s medical business from government intrusion. Our team of former healthcare prosecutors and experienced criminal defense attorneys have a distinguished history of protecting business owners, executives, lawyers, physicians, hospitals, laboratories, pharmacies, home healthcare entities, and many other healthcare organizations against any form of alleged healthcare fraud. With skilled legal representation, we aim to achieve a favorable outcome for our clients, which may involve reduced charges or other beneficial conditions. We offer a free consultation at our first contact. Here are some recent examples of our case outcomes.
- Representation of a Pharmacy Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud. Result: No civil or criminal liability.
- Representation of a Marketing Group Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud. Result: No civil or criminal liability.
- Representation of Physicians Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud. Result: No civil or criminal liability.
- Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for Alleged Medicare Fraud. Result: No civil or criminal liability.
- Representation of Laboratory against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud. Result: No civil or criminal liability.
- Representation of Laboratory against an Investigation by the Department of Justice and the U.S. Attorney’s Office for alleged Tricare Fraud. Result: No civil or criminal liability.
- Representation of a Healthcare Services Company against an Investigation by the Office of Inspector General, the Department of Justice, and the Department of Health and Human Services for Alleged False Claims Act and Stark Law Violations. Result: No civil or criminal liability.
- Representation of a Healthcare Marketing Group Against an Investigation by the Office of Inspector General for Alleged Healthcare Fraud. Result: No civil or criminal liability.
- Representation of a Physician against an Investigation by the Department of Health and Human Services and the U.S. Attorney’s Office for Alleged Medicare Fraud, Stark Law Violations, and Anti-Kickbacks. Result: No civil or criminal liability.
- Representation of Laboratory against an Investigation by the Department of Justice and the Office of Inspector General for Alleged False Claims Act and Medicare Violations. Result: No civil or criminal liability.
- Representation of Physician Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud and False Claims Act Violations. Result: No civil or criminal liability.
- Representation of Physician Investigated by the Office of Inspector General for Medicaid Fraud and Stark Law Violations. Result: No civil or criminal liability.
- Representation of Healthcare Organization Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud. Result: No civil or criminal liability.
- Representation of Physician Group Investigated by the Department of Justice and the Office of Inspector General for Medicare Fraud, Stark Law Violations, and False Claims Act Violations. Result: No civil or criminal liability.
- Representation of Physician Group Investigated by the Department of Health and Human Services and the Office of Inspector General for False Claims Act Violations. Result: No civil or criminal liability.
- Representation of a Physician Investigated by the Department of Defense and the Office of Inspector General for Tricare Fraud. Result: No civil or criminal liability.
- Representation of Pharmacy Investigated by the Department of Justice and the Office of Inspector General for Department of Labor Program Fraud. Result: No civil or criminal liability.
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Including Weekends
Oberheiden, P.C.
Serving Lakeland, Florida and Surrounding Areas
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