Oakland Healthcare Fraud Attorneys

Proven Oakland Healthcare Fraud Defense Attorneys

A federal healthcare fraud investigation can lead to financial penalties, program exclusion, licensing action, and even prison time. If your healthcare practice or business is under scrutiny, our Oakland healthcare fraud defense lawyers can help protect your career, your reputation, and your future.

Facing a federal investigation is one of the biggest risks to a provider’s business or practice. Federal agencies including the:

• U.S. Department of Justice (DOJ),
• Drug Enforcement Administration (DEA),
• Federal Bureau of Investigation (FBI), and
• Office of Inspector General (OIG).

These agencies conduct investigations in Oakland and throughout California. A targeted provider can face:

• Fines,
• Assessments,
• Recoupments,
• Denial of payment,
• Program exclusion, and
• Other penalties.

In criminal investigations, Oakland healthcare providers can also face long-term imprisonment.

Oberheiden, P.C.’s federal healthcare fraud defense team is composed of senior defense lawyers. Several served for years with the DOJ. Our team works to defend clients against healthcare fraud allegations. Anything from billing and coding violations to payment of unlawful referral fees, we can help. Our team has resolved countless complex and high-stakes investigations in California and nationwide. Our Oakland healthcare fraud attorneys aggressively emphasize early intervention and pre-indictment resolution. We do so while remaining fully aware of each client’s case’s unique facts and situation.

If your medical industry business or your practice is under federal investigation, you need experienced legal counsel. The agents, prosecutors, and task forces that handle healthcare fraud cases have in-depth knowledge and are very good at what they do. They work to secure recoupments, move unethical providers out of Medicare and Medicaid, and obtain criminal convictions. No matter the circumstances involved, you have defenses available. Protecting yourself starts with knowing how to use them effectively.

What Is Healthcare Fraud?

What does it mean to be accused of “healthcare fraud”? Healthcare fraud involves any unlawful attempt to obtain payment regarding the delivery, or purported delivery, of healthcare services, equipment, or supplies. The list of practices seen as healthcare fraud is nearly endless. We represent:

• Physicians,
• Clinic operators,
• Home health agencies,
• Hospices,
• Testing laboratories,
• Pharmacies, and business executives.

They all face allegations such as:

• Submitting improper billing codes to Medicare, Medicaid, Tricare, and the Department of Labor (DOL);
• Billing for services, supplies, or equipment at a higher rate than the one prescribed by the applicable billing regulations (known as “upcoding”);
• Billing for services, supplies, and equipment at individual billing rates rather than the bundled rates prescribed in the regulations (known as “unbundling”);

• Billing for medically unnecessary procedures under the applicable program billing regulations;

• Billing for services that are not actually rendered to patients (known as “phantom billing”);
• Offering or accepting unlawful “kickbacks” or making unlawful “self-referrals” in connection with program-reimbursed medical services, supplies, or equipment;
• Forging and falsifying prescriptions, diverting medications to drug-dependent individuals, and other forms of pharmaceutical fraud; and
• Falsifying patient records, prescriptions, physician certifications, and election statements.

Do you know why your healthcare practice or business is under investigation for federal healthcare fraud? Most likely not. Federal agents and prosecutors play their cards close to the vest. Finding out what you are defending yourself against is one of the first steps in avoiding civil and criminal charges.

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 Federal Healthcare Laws and Regulations Involved in DOJ, DEA, FBI, and OIG Investigations?

1. Anti-Kickback Statute

The Anti-Kickback Statute (AKS) applies to all healthcare providers and other businesses in the healthcare industry that bill Medicare, Medicaid, Tricare, or the DOL. It prohibits practitioners, business owners, and others from offering, paying, soliciting, or receiving referral fees and all other forms of “remuneration” concerning referrals for medical care reimbursed services, equipment, or supplies. The Anti-Kickback Statute includes provisions for civil and criminal penalties. And while most AKS investigations are civil, providers targeted in AKS investigations cannot rule out the possibility of criminal prosecution.

2. Controlled Substances Act

The Controlled Substances Act is one of the primary federal statutes used to prosecute healthcare providers suspected of pharmaceutical fraud and related prescription drug offenses. It is enforced by the DEA, that monitors and investigates both registered and unregistered providers.

3. False Claims Act

The False Claims Act (FCA) prohibits the submission of any “false or fraudulent” claim for payment by Medicare, Medicaid, Tricare, or the DOL. It is one of the government’s strongest weapons in the fight against healthcare fraud. Most healthcare fraud investigations include allegations under the FCA. In addition to a False Claims Act investigation by federal authorities, the FCA also includes qui tam provisions allowing private citizens (typically dissatisfied patients and disgruntled former employees) to file “whistleblower” claims.

4. 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 or artifice—(1) to defraud any healthcare benefit program; or (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.” Like the False Claims Act, 18 U.S.C. 1347 is extremely broad in scope, and it allows federal prosecutors to pursue criminal charges against healthcare providers for a wide range of alleged offenses.

5. Stark Law

The Stark Law prohibits so-called “physician self-referrals.” Unlike the statutes discussed above, the Stark Law is exclusively civil in nature. This doesn’t mean physicians targeted under the law can be complacent. A civil enforcement action under the Stark Law can result in enormous financial penalties. Physicians under investigation for unlawful self-referrals can also face prepayment review of future claims, loss of program eligibility, loss of licensure, and prosecution under various other laws.

6. Program Billing Regulations

One of the first things health care providers can do to decrease their risk of federal prosecution is to implement a thorough compliance plan. The plan should seek to satisfy the requirements of relevant benefit programs. Providers not adhering to up-to-date compliance programs are almost certain to make mistakes. These mistakes can lead to liability under each of the statutes noted above.

7. Other Federal Criminal Laws

Federal prosecutors typically pursue charges for various offenses in criminal healthcare fraud cases. This includes violations of the Anti-Kickback Statute, False Claims Act, 18 U.S.C. 1347, and various other criminal statutes that apply in healthcare and non-healthcare cases. Our federal defense lawyers have represented healthcare providers nationwide accused of crimes, including:

• Bank fraud (18 U.S.C. 1344)
• Criminal conspiracy (18 U.S.C. 371)
• Distribution of controlled substances (21 U.S.C. 841)
• Identity theft (18 U.S.C. 1028A)
• Mail fraud (18 U.S.C. 1341)
• Money laundering (18 U.S.C. 1357)
• Tax fraud (26 U.S.C. 7206)
• Wire fraud (18 U.S.C. 1343)

Frequently Asked Questions

5 Reasons to Choose Oberheiden, P.C.’s Oakland Healthcare Fraud Defense Lawyers

As health care providers in Oakland, protecting yourself against civil or criminal penalties requires a proactive approach to ending the investigation of the federal government. This requires knowledge of the laws that apply and insights into how and why federal authorities pursue healthcare providers. When you choose Oberheiden, P.C.’s healthcare fraud defense attorney team to represent you:

• We immediately intervene in the government’s investigation. When you hire our firm to represent you, our Oakland healthcare fraud attorneys begin taking steps to intervene in the government’s investigation. This ensures that you don’t disclose more information than is necessary. It will also allow us to gather the information necessary to assert a strategic defense.

• You will have notable experience on your side. The attorneys on our federal healthcare fraud defense team have combined legal experience. With our team approach, you will have the full weight of this experience.

• We will pursue every opportunity for a quick and discrete resolution. Our goal in every case is to secure a favorable outcome before charges get filed. This ensures that the investigation will cause minimal disruption and reputational harm.
• We will fight to keep your investigation civil. Civil monetary penalties are something most providers can find a way to manage. Federal imprisonment, on the other hand, is not. Our Oakland healthcare fraud defense attorneys fight to keep your investigation civil in nature so that prison time is not on the table.
• You can rest assured that you are in good hands. Healthcare providers in Oakland, throughout California, and nationwide trust our federal healthcare fraud lawyers to represent them. With us, you can feel confident that your case is taken seriously and treated with care.

Contact Our Oakland Healthcare Fraud Lawyer About Your Healthcare Fraud Investigation

If your healthcare practice or business in Oakland, CA, is under investigation, it is important to speak with our Oakland healthcare fraud lawyers today. To schedule a free and confidential consultation at Oberheiden, P.C., call 888-680-1745 or inquire online now.