Nashville Healthcare Fraud Defense Lawyers - Oberheiden, P.C.
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Nashville Healthcare Fraud

Skilled Nashville Healthcare Fraud Defense Lawyers

High profile cases of Medicare fraud in Tennessee have raised the government’s focus on healthcare providers in the Nashville area. If your business or practice is a target for federal investigation, it’s critical to understand the risks involved. Contact our experienced Nashville healthcare fraud defense lawyers to discuss your case.

Nashville address – by appointment only:
5016 Centennial Blvd. Suite 200
Nashville, TN 37209
888-680-1745

Tennessee has been the site of several high-profile healthcare fraud investigations. This is since Vanderbilt University Medical Center agreed to pay $6.5 million to settle alleged Medicare billing violations. As a result, investigators increasingly target local providers for fines, recoupments, program exclusion, and other penalties.

If your Nashville-area healthcare business or medical practice is under investigation, it’s important to understand the risks involved. Penalties under the False Claims Act (FCA) and other statutes are applied on a per-claim basis. With fines of $21,000 per violation, providers accused of submitting “false and fraudulent” claims can easily suffer incredible financial liability. Adding in recoupments, treble damages (three times the government’s actual losses), and the potential for licensing action as well as loss of Medicare, Medicaid, and Tricare eligibility, means providers see their livelihoods in peril.

This all assumes the government’s investigation is civil in nature. In criminal investigations, penalties can easily include multi-million dollar fines and years, or decades, in federal prison. Most investigations targeting legitimate healthcare providers are civil in nature, but if prosecutors believe they have evidence of intent, they can bring criminal charges.

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)

Nationally-Recognized Healthcare Fraud Defense Team Representing Providers in Nashville, TN

Oberheiden, P.C.’s lawyers concentrate on defending providers and other entities in federal healthcare fraud investigations. With a national practice, we receive calls from providers in Tennessee and other areas throughout the country. This is due in part to the U.S. Department of Justice’s (DOJ) decision to place a team from its Opioid Fraud and Abuse Detection Unit in the state. We routinely hear from providers facing allegations ranging from prescription drug fraud to acceptance of unlawful referral fees.

Our healthcare fraud defense team is composed of highly-skilled senior attorneys. Many having noteworthy careers in the DOJ prior to entering private practice. With our team approach, each client receives the full benefit of our attorneys’ collective experience. When you engage our firm, the attorneys representing you against the government will include Dr. Nick Oberheiden. The founder and managing partner of the firm, Dr. Oberheiden is a well-regarded federal law healthcare fraud attorney. He successfully represents providers across the country in investigations, civil and criminal prosecutions, and appeals.

Meet the other attorneys on our healthcare fraud defense team.

“We have never dealt with legal counsel who is so down to earth and compassionate toward his clients. [Dr. Nick Oberheiden] has a level of compassion and dedication that one would only expect from a family member. He is responsive and has even worked with us on weekends . . . . In a situation where we felt like there was little hope, [Dr. Oberheiden] provided a bright light at the end of a dark tunnel. There is no one better and if you are seeking a Federal Criminal Attorney, you can’t go wrong with this gentleman. He has a heart for what he does that we don’t often see in today’s legal profession.” – Healthcare Provider, Firm Client

“[Oberheiden, P.C.] is unlike your stereotypical law firm. Their level of professionalism, dedication, and sensitivity to me and my situation made me feel comfortable and confident I was in the right hands. Hopefully I won’t find myself in a situation where I’d need law services again but if I did they would be the first I’d call.” – Healthcare Provider, Firm Client

Nashville Healthcare Fraud

Highly Experienced in All Healthcare Fraud Matters

We have a formidable background in federal healthcare fraud defense. Our work has involved all major law enforcement agencies and task forces. This makes us uniquely stationed to represent those with challenging allegations and uncertain futures. Our knowledge of the government’s healthcare fraud enforcement program lets us develop and carry out a defense plan. We strive to resolve matters as quickly and favorably as possible.

Our attorneys have notable experience on both sides of federal healthcare fraud investigations involving issues including, but not limited to:

  • Double-Billing. This is one of the most common allegations in healthcare fraud investigations. It involves billing the same program (such as Medicare, Medicaid, or Tricare) multiple times for the same service. It also covers billing multiple programs for the same service or item. Plus, billing the same service or item to a federal benefit program and a private insurer.
  • Billing for Medically-Unnecessary Services. Federal funds are available only for reimbursement of services, supplies, and equipment judged medically necessary under program rules. Billing past allowed length of stay, and violating other restrictions of medical necessity are likely to launch investigations.
  • Billing for Services Not Provided (“Phantom Billing”). Billing for services, supplies, and equipment not provided to a patient is a common allegation in fraud investigations. While some providers engage in so-called “phantom billing” purposefully, many of these cases involve clerical errors and other honest mistakes.
  • Billing for Non-Allowable Costs. Certain costs, such as operating costs, are not eligible for reimbursement under Medicare, Medicaid, or Tricare. Attempting to bill for these costs can trigger investigations into other aspects of a providers’ billing practices as well.
  • Billing for Unlicensed or Excluded Services. Program regulations bar providers from billing for services provided by unlicensed practitioners. Billing for services provided by excluded providers (including excluded third-party providers) is also prohibited.
  • Non-Compliance with Conditions. In addition to billing according to limitations on reimbursement eligibility, healthcare providers must also comply with procedural conditions for Medicare, Medicaid, and Tricare payment. In today’s environment, even technical violations may prompt exhaustive inquiries into providers’ billing practices.
  • Unbundling. Program billing regulations require certain services and items to be billed at “bundled” rates. Unbundling (whether intentionally or not) is another practice that can be the catalyst for invasive healthcare fraud investigations.
  • Up-Coding. Similar to unbundling, up-coding involves billing for a service or item at a higher reimbursement rate than the one that should be used. Also similar to unbundling, up-coding can trigger investigations that lead to civil or criminal charges.
  • Use of Incorrect Billing Code. Using the incorrect billing code can be an unintentional form of upcoding. Providers need up to date compliance controls in place to avoid submitting incorrect billing codes and garnering the attention of federal authorities.
  • Kickbacks, Bribes, and Referral Fees. The Anti-Kickback Statute prohibits most forms of compensation (or “remuneration”) in connection with purchases, leases, and patient referrals involving funds from federal healthcare benefit programs. Unless a transaction qualifies for a statutory or regulatory safe harbor, providers on both sides of the transaction risk civil and criminal penalties.
  • Physician “Self-Referrals”. The Stark Law prohibits transactions of federally-reimbursed funds between physicians and entities or individuals with which they have financial relationships. It applies to non-exempted transactions related to “designated health services,” which include:
    • Clinical laboratory services,
    • Imaging,
    • Hospital services,
    • Outpatient prescriptions,
    • Physical therapy, and
    • Radiology, among others.
  • Falsifying Patient Records. This is another practice that, committed intentionally or not, is likely to trigger a federal inquiry. This includes:
    • Backdating records,
    • Falsely reporting test results,
    • Fabricating office visits, and
    • Various other forms of fraud.
  • Prescription Drug Diversion. With the DOJ’s heightened attention on healthcare providers’ opioid prescription practices, investigations of alleged opioid diversion have become increasingly common. Likely allegations include selling prescriptions, dispensing opioids without valid prescriptions, and dispensing prescription medications without medical necessity.
  • Drug Shorting and Refill Schemes. These schemes are commonly used to divert prescription medications as well. They are also common reasons for federal prescription drug fraud investigations.
  • Compound Pharmacy Fraud. With resurgence in compound pharmacy practice, the number of investigations targeting compound pharmacies has increased as well. Allegations against such pharmacies run the gamut from accepting kickbacks to billing for individual ingredients not medically necessary.
  • Other Forms of Prescription Drug Fraud. Other common allegations against physicians, pharmacists, clinics, and other providers whose practices involve prescription medications include:
    • Forging prescriptions,
    • Dispensing more medication than was prescribed,
    • Illegally importing medications and ingredients,
    • Prescribing or administering medications without medical necessity, and
    • Prescribing medications without conducting in-person exams.
  • Physician Certification Fraud. Physician certifications are a central component of program-reimbursed home health and hospice care practice. Providing fraudulent and forged certifications, backdating recertifications, and other forms of fraud can expose certifying physicians, home health agencies, and hospices to both civil and criminal penalties.
  • Election Statement Fraud. This is a common allegation in federal investigations targeting hospices as well. It includes treating patients without obtaining valid election statements, failing to maintain adequate patient records, forging and backdating election statements, and various other forms of fraud.

Nashville Healthcare Fraud Defense Lawyers: Answers to FAQs

Q: Which federal authorities are typically involved in healthcare fraud investigations?

Numerous federal authorities pursue investigations against healthcare providers in the Nashville area. This includes federal healthcare and law enforcement agencies, as well as special task forces formed for the specific purpose of pursuing recoupments and penalties for federal healthcare benefit program fraud. Our Nashville healthcare fraud defense lawyers routinely represent clients in matters involving the:

  • Centers for Medicare and Medicaid Services (CMS)
  • Department of Defense (DOD)
  • Department of Health and Human Services (DHHS) Office of Inspector General (OIG)
  • Department of Justice (DOJ)
  • Department of Labor (DOL)
  • Drug Enforcement Administration (DEA)
  • Federal Bureau of Investigation (FBI)
  • Medicare Fraud Strike Force
  • Opioid Fraud and Abuse Detection Unit
  • U.S. Attorney’s Office

Q: What types of referral fee arrangements are permissible under the Anti-Kickback Statute and the Stark Law?

Despite the broad prohibitions under the Anti-Kickback Statute and Stark Law, numerous forms of compensation-based arrangements are permissible. For example, statutory and regulatory safe harbors exist for transactions involving:

  • Arrangements with hospitals
  • Bona fide employment relationships
  • Compensation of non-physician practitioners
  • Cooperative health service organizations
  • Electronic health record and prescription services
  • Fair-market-value compensation
  • Group purchasing organizations
  • Indirect compensation arrangements
  • In-office ancillary services
  • Incidental benefits and non-monetary compensation
  • Investment interests
  • Isolated transactions

If you have been accused of offering or accepting an illegal kickback, bribe, or referral fee, our Nashville healthcare fraud defense attorneys can examine the transaction to determine if a safe harbor or defense is applicable to protect you from liability.

Q: What are the civil and criminal penalties for healthcare fraud?

The civil and criminal penalties for healthcare fraud vary by statute. Under the False Claims act, civil penalties include:

  • Fines of approximately $21,000 per fraudulent claim,
  • Recoupments,
  • Treble damages, and
  • Program exclusion.

In criminal cases, providers can face:

  • Fines of $250,000 for individuals (or $500,000 for businesses), and
  • Up to five years of federal imprisonment.

The Anti-Kickback Statute imposes similar civil penalties plus:

  • Up to $50,000 in civil monetary penalties (CMP) per violation,
  • Criminal defendants can face five-figure fines, and
  • Long-term imprisonment.

In criminal cases, providers will often face prosecution under a variety of other federal laws as well. Charges for:

  • Conspiracy,
  • Controlled substance offenses,
  • Mail fraud,
  • Wire fraud,
  • Money laundering, and
  • Other crimes can easily result in multi-million-dollar exposure and the potential for, under the worst facts, decades of federal incarceration.

In criminal cases, providers will often face prosecution under a variety of other federal laws as well. Charges for conspiracy, controlled substance offenses, mail fraud, wire fraud, money laundering, and other crimes can easily result in multi-million-dollar exposure and the potential for, under the worst facts, decades of federal incarceration.


Why Choose Oberheiden, P.C. in Nashville, TN?

1. Prosecutorial Experience

Our healthcare fraud defense team includes several attorneys who were senior healthcare fraud prosecutors with the U.S. Department of Justice. Our Nashville healthcare fraud defense lawyers have had success on both sides of federal healthcare fraud investigations, and in some cases, helped craft strategies still in use at the DOJ.

2. Proven Results

We have resolved an overwhelming percentage of our clients’ cases without federal indictments. To date, we have resolved 100 percent of False Claims Act investigations without civil or criminal liability. Not a single client of our firm has been forced to cease operations due to an investigation where we have been involved.

3. Exclusive Focus

Our practice is devoted to healthcare fraud defense. We constantly focus on defending clients in federal healthcare fraud investigations, and we take pride in finding new and innovative ways to defend our clients against the government’s evolving tactics.

4. Team-Oriented Representation

We do not assign cases to individual attorneys. Each member of our firm will contribute his or her experience to helping you avoid civil and criminal responsibility.

5. 24/7 Accessibility

We are available when and where you need us. We understand that your patients are your top priority, and we can work with you to minimize the impact of an investigation on your business or practice as much as possible.

Get Started with a Free and Confidential Case Assessment

For more information about our healthcare fraud defense practice, please contact us to schedule a free and confidential case assessment. You can reach us 24/7 at 888-680-1745, or send us your contact information and our Nashville healthcare fraud defense lawyers will be in touch as soon as possible.

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.
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