Northern Florida Healthcare Fraud Attorneys
If you are being investigated for healthcare fraud in Northern Florida, you need the experienced Northern Florida Healthcare Fraud Defense Lawyers at Oberheiden, P.C.
Northern Florida Healthcare Fraud Defense Team Lead
Former Deputy Chief, Appellate Division
1111 East Tennessee Street
Tallahassee, FL 32308
888-680-1745
Oberheiden, P.C., is a federal healthcare fraud defense firm that represents health care providers, including professionals, corporate officers, owners, and business entities in civil and criminal investigations in the northern areas of Florida.
It is more important now than ever that healthcare providers in North Florida contact experienced defense. Relatively few criminal defense law firms focus almost exclusively on white-collar federal criminal defense. And, federal agents target the healthcare industry as never before.
The Northern Florida healthcare fraud defense lawyers at Oberheiden, P.C., offer more than 100 years of cumulative legal experience in health law practice. We have a record of persuading federal prosecutors not to file charges against the majority of our clients and often to drop them if charges are already filed.
Several of our lawyers are former federal prosecutors. We have extensive experience in negotiating directly with agencies like the Drug Enforcement Administration (DEA), Health Care Compliance Association (HCCA), and the Department of Health and Human Services Office of the Inspector General (DHSS – OIG).
What Is Healthcare Fraud?
There are many ways to commit healthcare fraud under federal law. Congress has enacted numerous criminal statutes aimed at the problem of fraud, waste, and abuse in healthcare. Many of these laws carry severe penalties. Prosecutors are known for pursuing the most charges and counts possible and for seeking the harshest sentences. That’s why an aggressive criminal defense against any accusation of healthcare fraud is so important.
Some of the healthcare fraud allegations that our team has defended against include:
- Billing fraud (Medicare, Medicaid, Tricare, etc.)
- Department of Labor (DOL) fraud
- Anti-Kickback Statute violations
- Stark Law violations (physician self-referral)
- Controlled Substances Act / DEA registration violations (including prescription drug fraud)
- Providing / Billing for medically unnecessary services
- Billing for services not actually rendered to patients
- Falsifying patient records, prescriptions, physician certifications, or election statements
Details matter. The details of government investigations dictate which defense strategies will serve you best. To find out what kind of healthcare fraud we’re really dealing with, we try to get answers to two key questions right away:
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Are the internal investigations currently oriented toward a civil enforcement proceeding or a criminal prosecution?
- Which federal law enforcement agencies and/or task forces are involved?
By answering these questions, we can determine where your case currently stands and how to avoid and defeat prosecution, or crippling civil fines.
The Most Commonly Invoked Healthcare Fraud Laws
Below, we review a handful of the most common statutes, laws, regulations, and directives resulting in criminal prosecution of healthcare professionals in Northern Florida.
1. The False Claims Act
The False Claims Act (FCA) is also known as “The Lincoln Law,” because it was enacted in 1863 under the presidency of Abraham Lincoln. The law has been modified many times since then and has given the government more power over time. The FCA makes it a crime to submit “false or fraudulent” payment claims to federal benefits programs. The FCA also contains qui tam provisions, incentivizing private whistleblowers whose civil claims can trigger criminal investigations on the government’s behalf. FCA penalties are applied per claim, so they can quickly add up to a huge dollar amount. Additional penalties on a False Claims Act case may include exclusion from federal benefits programs and a potential prison sentence.
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) applies civil and/or criminal penalties to healthcare organizations and providers who offer, solicit, pay for or receive remuneration (for example, a referral fee) for referring a government health program beneficiary. The term “kickback” might seem common. The government, however, has brought AKS charges against providers whose conduct didn’t appear to be a “kickback” so much as a good-faith business arrangement. Contact our Northern Florida healthcare fraud attorneys immediately if you are accused of violating the AKS.
3. The Stark Law
The Stark Law makes it unlawful for a physician to make “self-referrals.” With the Stark Law, the government hopes to prevent doctors from profiting from their own referrals. That might sound sensible in theory. In practice, however, the government has used the statute aggressively. This has resulted in unfair and excessive financial penalties for healthcare providers who simply tried to get patients the best care. Our healthcare fraud defense attorneys are available to assist any physician or healthcare business accused of Stark Law violations in Northern FL.
4. The Controlled Substances Act (CSA)
The Controlled Substances Act established the United States’ federal drug policy. It controls the manufacture, distribution, importation, possession, and use of an array of substances. Included are illegal drugs and prescription medications. The DEA investigates healthcare providers in Northern Florida in a variety of CSA-related matters, including:
- Pharmaceutical fraud
- Prescribing unnecessary medication
- Diverting opioids or other prescription drugs
- “Selling” prescriptions
- Providing addictive drugs to addicted patients
- Other unlawful prescription practices
Most “pill mill” or “pain mill” investigations in Northern FL fall under the CSA.
5. The Federal Healthcare Fraud Statute
18 U.S.C. 1347 contains the country’s general “healthcare fraud statute,” which makes it illegal to:
“knowingly and willfully execute, or attempt to execute, a scheme or artifice –
(2) to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any healthcare benefit program.”
Owing to the broad nature of its plain text, 18 U.S.C. 1347 might appear on a list of charges in nearly any healthcare fraud case in North Florida.
6. Other Fraud Statutes
In addition to the criminal statutes above, healthcare providers frequently face allegations of other charges:
- Wire fraud
- Mail fraud
- Forgery
- Making false statements
- Federal conspiracy
- Wrongful use of health information
- Other serious charges
7. Program Billing Regulations
Federal healthcare benefits programs establish their own rules and regulations. Violations of which, even if unintentional, may have serious effects. These program billing regulations change with some frequency, making compliance a challenge. Care providers in Northern FL can mitigate their risk of prosecution by maintaining an active, up-to-date compliance program.
8. DOJ Mandates
Mandates from the Department of Justice are public announcements or internal instructions about which cases DOJ agents should prioritize. Currently, healthcare fraud and opioid diversion are among the Department’s top priorities. In fact, the Department created two collaborative task forces – the Opioid Fraud and Abuse Detection Unit and the Prescription Interdiction & Litigation (PIL) Task Force.
5 Reasons to Trust the Northern Florida Healthcare Fraud Attorney at Oberheiden, P.C.
Here are five reasons why healthcare providers and other Medicare, Medicaid, and Tricare participants should choose Oberheiden, P.C., as their Northern FL healthcare fraud defense team:
- Our Extensive Experience in Healthcare Fraud Investigations – Our Northern Florida healthcare fraud defense lawyers have handled thousands of internal compliance audits, investigations, and prosecutions on behalf of healthcare providers in FL and nationwide.
- Our Record of Avoiding Charges – In the majority of our cases, our attorneys have been able to end criminal investigations without the filing of criminal charges.
- Our Focus on Federal Healthcare Fraud Defense – Healthcare fraud defense is one of our primary interests. Our skilled Northern FL healthcare fraud defense lawyers have represented:
- Physicians,
- Pharmacists,
- Clinics,
- Labs,
- Hospitals,
- Hospices, and
- Virtually every other category of healthcare provider.
- Our Experience on Both Sides – Several senior criminal defense lawyers on our team are former federal prosecutors. They spent years working for the federal government. This “dual perspective” helps us negotiate effectively with current federal agencies.
- Our Aggressive Defense Strategies – We take an aggressive approach to defending our clients in every single case. We know the incredibly high stakes demand we give our passion and energy to every case, every day.
Don’t make the mistake of facing the state and federal courts on your own. Choosing the right law firm could become the most important decision you will ever make.
Frequently Asked Questions
Which federal agencies are responsible for investigating healthcare fraud allegations?
Every healthcare fraud investigation is different, but the FBI typically spearheads most cases. However, the FBI relies on the assistance of many other federal agencies, including:
- The Office of Inspector General (OIG)
- The Centers for Medicare and Medicaid Services (CMS)
- The Department of Health and Human Services (HHS)
- The Department of Defense (DOD)
- The Drug Enforcement Administration (DEA)
- The Department of Justice (DOJ)
- The Department of Labor (DOL)
While conducting regular business, one of these agencies often come across information that raises a red flag. It may be that an audit didn’t go well. It’s possible a whistleblower contacted the agency after discovering what was believed to be evidence of fraud. The agency receiving this information may then conduct its own internal investigation. As soon as the agency believes the subject of the investigation committed fraud, it will typically get the FBI involved. If you are under investigation by the FBI or any other federal agency, it’s imperative to protect yourself and your business by contacting a Florida federal healthcare fraud defense attorney.
What does “qui tam” refer to?
Qui tam is a Latin phrase related to a civil case filed by an individual on behalf of the government. In the context of healthcare fraud claims, a qui tam lawsuit can be brought under the FCA. Specifically, when a person comes across evidence they believe shows healthcare fraud, they can file a case on their own or present the evidence to federal investigators. In some cases, the government determines that it will intervene in the lawsuit and take over the case. In others, the government will choose not to intervene. At this point, the whistleblower, or relator, has the choice of pursuing the claim on their own. If a whistleblower’s claim results in any award, they are entitled to a portion of the amount recovered, up to 30 percent. Qui tam lawsuits raise some serious concerns due to the financial incentives offered to whistleblowers. If you are facing a qui tam lawsuit, however, you must take the situation seriously. Contact a Northern Florida federal healthcare fraud defense attorney right away.
Should I speak with investigators about a healthcare fraud claim?
No––at least not without speaking to an experienced Florida federal healthcare fraud defense attorney first. Communicating, and even cooperating with federal investigators is not something to be ruled out in every case. However, the risks of doing so absent counsel are simply too great. When you speak with investigators, everything you say gets documented. So, if you leave out small, but important details, or make an innocent misstatement of fact, it can be seen as evidence of wrongdoing. It’s a better idea and much safer to work with a Northern FL federal healthcare fraud defense attorney to learn more about the investigation before responding to federal authorities.
Discuss Your Federal Health Care Fraud Investigation in Confidence With a Northern Florida Healthcare Fraud Lawyer
If your Northern FL healthcare practice or company is targeted in a federal healthcare fraud investigation, we strongly encourage you to contact us for a confidential case assessment. To speak with our Northern Florida healthcare fraud defense attorneys for free, call 888-680-1745 or inquire online, right away.
