Memphis Healthcare Fraud Attorneys

Proven Memphis Healthcare Fraud Defense Lawyers

For Memphis healthcare providers, the risk of being under federal investigation is a very real concern. Allegations of billing fraud, kickbacks, and other statutory violations can lead to civil or criminal charges. Avoiding substantial penalties requires a strategic and proactive defense. Contact our Memphis, Tennessee healthcare fraud defense lawyers to discuss your situation as soon as possible.

“Healthcare fraud” is a broad term that contains a range of federal offenses. It typically involves acquiring funds from Medicare, Medicaid, and Tricare improperly. Healthcare fraud can take a variety of forms. Health care industry providers in Memphis are targeted for alleged offenses from offering and accepting kickbacks to falsifying patient records.

You may feel confident managing compliance for federal healthcare programs. However, any inquiry from federal agents must be taken seriously. Federal investigations can quickly grow. Under the False Claims Act, Anti-Kickback Statute, and Stark Law, even unintentional violations can result in significant financial liability. Federal investigations can also trigger licensing action and other outcomes. Providers facing federal investigations must execute thorough defense strategies focused on their situation.

Strategic and Aggressive Memphis Healthcare Fraud Lawyers Representing Providers

Our firm’s experience allows us to obtain favorable results in many high-stakes fraud investigations. Specializing in the area of healthcare fraud defense, our Memphis healthcare fraud attorneys offer practical advice to providers facing fraud allegations from all federal law enforcement agencies and task forces. Whether you have received a civil investigative demand (CID), grand jury subpoena, or letter from the U.S. Attorney’s Office, we can advise you of the best path forward. a Memphis Healthcare Fraud Defense Lawyer can represent you in all contacts with federal authorities while guiding the investigation toward a favorable outcome.

At Oberheiden, P.C., we offer:

• Well over 100 years of combined experience in federal healthcare fraud investigations.
• Government-side knowledge and insights from attorneys with prior experience as healthcare fraud prosecutors with the U.S. Department of Justice prior to entering private practice.
• Real results for healthcare providers, including resolving 100 percent of False Claims Act investigations with no civil or criminal liability to date.
• A team-oriented approach means each senior healthcare fraud defense attorney works to help you avoid civil liability and criminal charges.
• Client-centric representation that includes prompt responses, customized legal strategies, and 24/7 access to attorneys on your defense team.

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 Our Clients Say

While we are more than happy to discuss our experience in healthcare fraud investigations and litigation, we also like to let our clients speak for themselves. Here are just two examples of testimonials from healthcare providers who have chosen the healthcare fraud defense team at Oberheiden, P.C.:

“Dr. Oberheiden has successfully represented our company in various federal health matters. . . . Dr. Oberheiden quickly understands all issues and is able to convincingly present the client’s side of the story. From my experience with other lawyers, I consider Dr. Oberheiden to be among the best attorneys we have ever used. Should we ever need legal help, the first thing our company will do is to call Dr. Oberheiden.” – Healthcare Provider, Firm Client

“Our experience with [Oberheiden, P.C.] was overwhelmingly positive! We recently brought a range of complex legal issues to the table, which they responded to with a systematic, prudent approach. Throughout our work together, Oberheiden, P.C. served as an invaluable source of practical guidance and legal leadership. We would recommend them highly and without reservation. . . .” – Healthcare Provider, Firm Client

20 Common Allegations in Federal Healthcare Fraud Investigations

There are unique parts to all federal investigations. Those targeting healthcare providers focus on specific types of allegations. Our defense team attorneys have been assisting clients with our extensive experience representing providers accused of various violations. They are knowledgeable, with proven skills in representing those accused of healthcare fraud.

1. Double-Billing

Double-billing can include:

• Submitting multiple claims for the same physician practices service or item to Medicaid, Medicare, Tricare, or other healthcare benefit programs,
• Submitting duplicate claims to multiple programs, or
• Submitting duplicate claims to a program and a private insurer.

2. Billing for Medically-Unnecessary Services

Medicare, Medicaid, Tricare, and other benefit program funds are available only for services and items the government deems medically necessary.

• Inpatient treatment lasting beyond the program-approved length of stay,
• Use of more-expensive treatment options when less-expensive services are available, and
• Providing necessary medications for non-necessary procedures are just a few examples of services that would be considered medically unnecessary under federal program billing guidelines.

3. Billing for Services Not Provided (“Phantom Billing”)

Billing for services, supplies, and equipment not actually provided to patients is referred to as “phantom billing”. It has the potential to carry both civil and criminal penalties. While some cases of phantom billing are intentional, many investigations target billings that are the result of administrative mistakes and other human errors.

4. Billing for Non-Allowable Costs

Some costs are eligible for program reimbursement, and some aren’t. Billing for non-allowable costs (such as operational expenses) is considered a form of healthcare fraud.

5. Billing for Unlicensed Services

Billing for services provided by unlicensed individuals is considered a form of healthcare fraud as well. This includes services provided by unlicensed therapists and counselors, physicians who have lost their medical licenses, and other unlicensed providers.

6. Billing for Excluded Service Providers

If a provider has been excluded from Medicare, Medicaid, Tricare, or another healthcare benefit program, billing for that provider’s services is considered fraud.

7. Non-Compliance with Conditions

In addition to only billing for approved services and products, providers must also submit all bills in compliance with applicable program terms and conditions. Non-compliance with conditions is grounds for denial of payment and recoupment of previously paid amounts.

8. Unbundling

Unbundling refers to billing services and items at their stand-alone rates when the applicable program regulations call for a reduced, “bundled” payment rate. Both intentional and unintentional unbundling can trigger federal inquiries and expose providers to financial penalties.

9. Up-Coding

Up-coding refers to billing one service as another to obtain the other service’s higher reimbursement rate. Up-coding is another form of billing and coding fraud that can lead to False Claims Act liability.

10. Use of Incorrect Billing Code

Other mistakes resulting in submission of an incorrect billing code can trigger False Claims Act liability. In most cases, federal healthcare fraud investigations target accidental billing mistakes. These are typically the result of administrative errors not deserving of criminal penalties.

11. Kickbacks, Bribes, and Referral Fees

The Anti-Kickback Statute generally bars payment of referral fees (referred to as “kickbacks” and “bribes” under the statute) out of federally-reimbursed funds. However, there are several safe harbors available. And, many types of referral fee arrangements are exempted from federal prosecution.

12. Physician “Self-Referrals”

The Stark Law is similar to the Anti-Kickback Statute in prohibiting types of compensation arrangements of federally-reimbursed funds. However, its scope is far more limited. The Stark Law prohibits certain payments in connection with referrals for “designated health services” involving physicians and their related entities. Similar to the Anti-Kickback Statute, various safe harbors and exceptions apply.

13. Fabricating Test Results or Providing Improper Treatment

This is another allegation in healthcare fraud cases that can involve intentional and unintentional violations. Often due to faults in providers’ record keeping, investigators allege providers’ program billings don’t reflect suitable treatment or prescription choices based on reported test results.

14. Falsifying Patient Records

In addition to asserting providers fabricate test results, federal agents accuse providers of falsifying other patient records as well. This can include billing for treatments or medications not provided, overreporting the duration of treatment sessions, and recording improper diagnoses to bill for unnecessary services or those not provided.

15. Prescription Drug Diversion

Diversion refers to providing prescription medications to those other than the patients to whom they have been, or should be, prescribed. Routinely targeted in investigations of prescription drug diversion are:

• Physicians and physician groups,
• Pharmacists,
• Clinics,
• Home health agencies,
• Hospices, nursing homes, and
• Other providers.

16. Drug Shorting and Refill Schemes

Drug shorting and refill schemes are common allegations in prescription drug fraud investigations as well. These cases focus on individual licensed professionals and staff members who may be diverting medications for sale or personal use.

17. Compound Pharmacy Fraud

Investigations targeting compound pharmacies often focus on unlawful kickback and referral fee arrangements. Or, on issues involving specific ingredients in compound medications. These matters are often highly-technical in nature. Our Memphis healthcare fraud attorneys have marked experience fending off federal inquiries on behalf of compound pharmacies and pharmaceutical companies.

18. Other Forms of Prescription Drug Fraud

Along with prescription drug diversion, drug shorting/refill schemes, and compound pharmacy fraud, providers are targets of other prescription-related offenses as well. This includes offenses such as:

• Dispensing more medication than prescribed
• Falsifying and forging prescriptions
• Illegally importing prescription medications
• Inaccurately reporting test results in order to issue prescriptions
• Prescribing medications without conducting in-person exams

19. Physician Certification Fraud

Home health agencies and hospices are subject to billing conditions beyond those of other providers. Included is the requirement to have physician certifications, and recertifications, for all benefit recipients. Failure to obtain them, forging them, and other fraudulent practices are common in cases against home health agencies and hospices in Memphis.

20. Election Statement Fraud

Along with getting certifications, hospices need valid election statements from program beneficiaries. Not notifying patients of their rights, falsifying election statements, and various other forms of fraud and abuse laws can set-off liability under the False Claims Act and other statutes.

FAQs: What You Need to Know if You Are Facing a Federal Healthcare Fraud Investigation

Additional Resources for Memphis, TN Healthcare Providers

Anti-Kickback Statute Investigations

• Anti-Kickback Statute Exceptions
• Medical Research Studies and Anti-Kickback Investigations
• Mistakes to Avoid in Anti-Kickback Investigations
• What You Should Do When You Are Under Investigation for Anti-Kickback Violations?

Compound Pharmacy Fraud Investigations

• Avoiding Criminal Charges in Tricare Compound Pharmacy Investigations
• Compound Pharmacy Investigations: Questions You Should Ask Your Attorney
• Defending Compound Pharmacies in Tricare Fraud Investigations
• What Is Compound Pharmacy Fraud?

False Claims Act Investigations

• 5 Things You Need to Know About the Federal False Claims Act
• Avoiding Criminal Charges in False Claims Act Cases
• False Claims Act & Qui Tam Defense
• What You Should Do When You Are Under a False Claims Act Investigation

Home Health Agency and Hospice Fraud Investigations

• What Home Health Agencies Should Do to Avoid a Government Investigation
• Home Health Fraud – Common Characteristics
• How to Defend Against Hospice Fraud Allegations
• The Federal Government Is Finding New, Aggressive Ways to Combat Home Health Fraud

Stark Law Investigations

• Important Differences between the Anti-Kickback Statute and Stark Law
• What Are the Compensation Arrangement Exceptions to the Stark Law?
• Stark Law Attorneys for Doctors

Request a Confidential Initial Consultation With Our Memphis Healthcare Fraud Lawyers

If you need Memphis healthcare fraud defense attorneys, we encourage you to contact us promptly for a free initial case assessment. The attorneys on our healthcare fraud defense team are standing by, and we are available to speak with potential clients 24/7. To request an appointment with a Memphis healthcare fraud lawyer at Oberheiden, P.C., please call 888-680-1745 or inquire online now.

Additional Pages for Memphis, Tennessee

• Memphis & Nashville physicians and healthcare business owners defense
• Memphis federal criminal defense
• Memphis federal appeals
• Memphis white collar criminal defense
This information has been prepared for informational purposes only and does not constitute legal advice. While this information may constitute attorney advertising in some jurisdictions, merely reading this information does not create an attorney-client relationship. Every case is different, any prior result described or referred to herein cannot guarantee similar outcomes in the future. Oberheiden, P.C. is a Texas limited liability partnership with its headquarters in Dallas, Texas. Mr. Oberheiden limits his practice to federal law.