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

Proven Oakland Healthcare Fraud Defense Attorneys

Dr. Nick Oberheiden
Attorney Nick Oberheiden
Oakland Healthcare Defense
Team Lead envelope icon Contact Nick
Oakland address – by appointment only:
2323 Broadway
Oakland, CA 94612
888-680-1745

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 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. We use an aggressive approach emphasizing early intervention and pre-indictment resolution. We do so while remaining fully aware of the unique facts and situation of each client’s case.

If you, your business, or practice is under federal investigation, you need experienced legal counsel. The agents, prosecutors, and task forces that handle healthcare fraud cases 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 services that are deemed medically unnecessary 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
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)

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” in connection with referrals for program-reimbursed services, equipment, or supplies. The Anti-Kickback Statute includes provisions for civil and criminal penalties. And while most AKS investigations are civil in nature, 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 healthcare providers can do to decrease their risk of federal prosecution is to implement a thorough compliance plan. The plan should seek to satisfy requirements of relevant benefit programs. Providers who do not adhere 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

In criminal healthcare fraud cases, federal prosecutors typically pursue charges for a variety of offenses. This includes not only violations of the Anti-Kickback Statute, False Claims Act, and 18 U.S.C. 1347, but also various other criminal statutes that apply in both 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

What happens if I am liable for a patient overdose?

 

Opioid-related overdose deaths pose an extreme risk to doctors and pharmacy owners. If found guilty, a federal sentencing judge can consider a life sentence. This can happen if the court is convinced the physician’s prescription caused the patient’s death and appropriate precautions were not in place to protect the safety and life of the deceased.

What should I look for in an Oakland, California federal healthcare fraud defense attorney?

 

If you believe you or your practice or organization is under investigation by the federal government, your choice of attorney may be the most important decision you make. When interviewing attorneys to represent your interests, be sure to select an Oakland federal healthcare fraud defense attorney or law firm that has specific experience handling federal healthcare fraud cases. Better yet, find a law firm that has multiple attorneys who used to prosecute healthcare fraud cases. This provides the attorney with insight into how the government builds its case. Such an attorney can also help minimize your exposure, and develop an effective defense strategy.

What is a qui tam lawsuit?

 

The term qui tam refers to a lawsuit brought by an individual on behalf of the federal government. The most common use of the term is for whistleblowers who provide evidence of healthcare fraud to federal agencies. When a whistleblower provides information to the government, it will begin its own investigation. The federal government may then decide to intervene in the case, which means they will take over from there. If the government chooses not to intervene, the whistleblower can still continue the action on behalf of the government. Whether the government takes the case or not, the whistleblower is entitled to a percentage of whatever amount is recovered. If you are facing allegations brought by a whistleblower, it’s important to take them seriously. You must consult with an experienced a California federal healthcare fraud defense attorney promptly.


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

Oakland Healthcare Fraud Defense Lawyers As a healthcare provider in Oakland, protecting yourself against civil or criminal penalties requires a proactive approach ending the government’s investigation. 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, we 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 on your side.
  • 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 Us About Your Oakland 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 defense attorneys today. To schedule a free and confidential consultation at Oberheiden, P.C., call 888-680-1745 or inquire online now.

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All website terms, conditions, and disclaimers apply to this information and are hereby fully incorporated. Specifically, this information has been prepared (1) for informational purposes only and does not constitute legal advice; (2) This information may constitute attorney advertising in some jurisdictions; (3) Merely reading this information does not create an attorney-client relationship; (4) Attorneys of Oberheiden, P.C., are not licensed in all states but are only licensed to practice in the states mentioned in their respective biographies. Nothing contained in here is meant to constitute the unauthorized practice of law or a suggestion of physical presence in the state; (5) Prior results do not guarantee similar outcomes in the future.
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