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

Linda Julin McNamara
Attorney Linda Julin McNamara
Orlando Healthcare Fraud Defense Team Lead
Former Deputy Chief, Appellate Division
Orlando address – by appointment only:
7726 Winegard Rd 2nd Floor
Orlando, FL 32809
407-706-9203

What does it mean to be targeted in a federal healthcare fraud investigation? Depending on the allegations, it could be fines, program exclusion, loss of licensure, and even federal imprisonment. For a free and confidential case assessment, call our Orlando healthcare fraud defense lawyers at 407-706-9203 now.

Facing federal healthcare fraud allegations is serious. These are some of the agencies that target providers in Orlando and other major cities throughout Florida:

  • Department of Justice (DOJ),
  • Drug Enforcement Administration (DEA),
  • Office of Inspector General (OIG), and
  • Medicare Fraud Strike Force

These cases are often misguided. However, physicians, pharmacists, and other providers who don’t defend themselves can face a damaged reputation, financial penalties, and loss of program involvement. In the worst cases, federal prison time could be on the table.

At Oberheiden, P.C., we provide legal counsel for healthcare providers facing federal investigations in Orlando, FL. Our team of highly experienced defense attorneys and former federal prosecutors has advised thousands of clients in fraud cases. If you are a target for falsely billing Medicaid or Tricare, or using Medicaid-reimbursed funds for illegal referral fees, you have options. Our Orlando healthcare fraud defense lawyers use their experience to protect you from undue prosecution.

With federal healthcare fraud, prompt intervention and a proactive defense are keys to avoiding costly outcomes. If at all possible, you need to close your case before it leads to federal charges. We have resolved the vast majority of our clients’ cases without charges filed. These actions protected our clients against criminal indictments.

What Is Healthcare Fraud?

“Healthcare fraud” is a complicated term. Unlike other forms of fraud – like bank, mortgage, and insurance fraud – healthcare fraud is not a clearly defined offense. Instead, “healthcare fraud” is a broad term that describes a variety of different civil and criminal offenses. The offenses are alike in that improperly obtained funds from a federal healthcare benefit program are involved.

This presents certain challenges in DOJ, DEA, OIG, and Medicare Strike Force investigations. In order to defend yourself effectively, you first need to know exactly what you must defend against. Facing allegations of “healthcare fraud” could mean accusations ranging from:

  • Overbilling Medicare, Medicaid, Tricare, or the Department of Labor (DOL)
  • Billing Medicare, Medicaid, Tricare, or the DOL for medically-unnecessary services or supplies
  • Billing Medicare, Medicaid, Tricare, or the DOL for services or supplies not actually rendered to patients
  • Offering, paying, soliciting, or accepting an illegal “kickback” or referral fee
  • Improperly prescribing, administering, or dispensing prescription medications (such as prescription opioids)
  • Falsifying patient records, prescriptions, physician certifications, and election statements

Intervening in the government’s investigation will lead to the reason for the probe. This requires the services of an experienced and highly capable defense team. Our Orlando healthcare fraud defense lawyers have experience in intervening on behalf of our clients. We quickly make contact with the federal agents and prosecutors handling your investigation to determine:

  • What specific allegations triggered the investigation?
  • What was the source of the original allegations?
  • Is anyone else under investigation?
  • How long has the investigation been ongoing?
  • What evidence has the government collected to date?
  • Is the investigation currently civil or criminal in nature?

With this information, our team can customize a strategy to resolve the matter quickly and with the least publicity.

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)

Sources of Authority in Federal Healthcare Fraud Investigations

1. The False Claims Act

The False Claims Act (FCA) bars filing any “false or fraudulent” claim for payment by a federal healthcare benefit program. If an investigation reveals evidence of intent, FCA charges can be civil or criminal in nature. Potential penalties include civil monetary penalties, criminal fines, and federal imprisonment.

2. The Anti-Kickback Statute (AKS)

Federal law bans offering, paying, soliciting, and receiving referral fees or other forms of payment for federally funded medical services and equipment. Like the False Claims Act, the AKS includes both civil and criminal enforcement provisions. The AKS’s broad prohibitions are subject to several statutory safe harbors. These safe harbors provide complete defenses in many cases.

3. The Stark Law

The Stark Law prohibits physicians from referring patients to entities in which they or a close family member has a financial interest. Physician “self-referrals” can lead to civil penalties, including fines, recoupments, and treble damages. The Stark Law includes various safe harbor provisions. Our attorneys have experience using these safe harbors to protect clients.

4. The Controlled Substances Act

The Controlled Substances Act (CSA) imposes criminal penalties for assorted prescription drug-related offenses, including various forms of prescription drug fraud. The CSA also provides authority for the DEA’s registration enforcement program. Registered healthcare providers can face both routine and unannounced inquiries targeting their prescription practices.

5. The Federal Healthcare Fraud Statute

The healthcare fraud statute, 18 U.S.C. 1347, makes it a federal offense to “knowingly and willfully . . . (1) . . . defraud [or attempt to defraud] any healthcare benefit program; or (2) . . . obtain [or attempt 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.” Orlando healthcare providers singled out for prosecution under 18 U.S.C. 1347 can face huge fines and the potential for ten, twenty, or even life in federal prison.

6. Program Billing Regulations

Providers filing claims to federal healthcare benefit programs are subject to strict billing and coding regulations. Both intentional and unintentional violations can trigger government attention. Sadly, these regulations frequently change. This forces providers to maintain up to date https://federal-lawyer.com/healthcare-compliance/>compliance programs in order to mitigate their risk of severe outcomes.

7. DOJ Mandates

The Department of Justice routinely issues releases identifying new law enforcement priorities and task forces. Increasingly, these initiatives target providers and entities in the healthcare industry. Recent initiatives include the Opioid Fraud and Abuse Detection Unit and Prescription Interdiction & Litigation Task Force. These groups combine the DOJ’s resources with those of other federal law enforcement agencies.

5 Reasons Healthcare Providers Choose the Orlando Healthcare Fraud Defense Lawyer at Oberheiden, P.C.

Orlando Healthcare Fraud Defense Lawyers If your Orlando medical practice or healthcare business is under investigation by federal authorities, you need to speak with an experienced defense attorney as soon as possible. At Oberheiden, P.C., we put an entire team of federal healthcare fraud defense attorneys on your side. Our team works to execute customized defense strategies to protect our clients efficiently and thoroughly. They do this by relying on knowledge gained from thousands of investigations and hundreds of trials.

What else you can expect when you choose Oberheiden P.C. for your federal healthcare fraud investigation in Orlando, FL?

  • Aggressive Intervention – Our Orlando healthcare fraud defense attorneys aggressively intervene in the government’s investigation to build a strategic defense right away.
  • Focus on Resolution Prior to Charges – All of our initial efforts will be on securing a favorable resolution prior to charges being filed. The reason for this is simple: If you aren’t charged, you can’t be convicted.
  • Strategic Pretrial Practice – If federal prosecutors decide to file civil charges or seek an indictment, we work strategically to fight the charges and convince the DOJ it does not have a case for trial.
  • Savvy Trial Representation – The details of your case may indicate that going to trial is your best option. In such cases, our attorneys will use their vast federal trial experience to fight for a “not guilty” verdict.
  • Personalized Professional Representation – No matter the details of your case, we provide personalized and professional representation. Our attorneys’ exceptional experience representing clients in critical federal matters defines our work.

Frequently Asked Questions

What is the difference between the Anti-Kickback Statute and the Stark Law?

 

The Anti-Kickback Statute (AKS) and the Stark Law limit a medical provider’s ability to refer patients in certain situations. The AKS deals with patients whose medical expenses are paid by a federally funded program. Specifically, the AKS forbids any referral fee, monetary or otherwise. The Stark Law bars most cases of physician self-referrals. This is where a provider refers a patient to another provider in whom the referring physician has an economic interest. The Stark Law applies to any patient, not just one who is covered under a federal program. The other significant difference between the two laws is that the AKS is a criminal law statute, carrying a maximum penalty of five years in prison and a fine of up to $25,000. The Stark Law is a civil statute and carries a maximum penalty of $15,000 per violation. If you are under investigation for any type of healthcare fraud, it is vital to contact an experienced Orlando, Florida federal healthcare fraud defense attorney today.

Can whistleblowers bring federal healthcare charges?

 

Under the False Claims Act, yes, they can. Someone with information about a potential violation of federal healthcare fraud laws can bring a whistleblower lawsuit. Often in the hopes of gaining a financial reward. Whistleblowers may be current or former employees, business associates, patients, customers, or anyone who has information they believe shows a violation of federal law. All whistleblower claims are brought under the False Claims Act. However, the alleged violation can be for any federal healthcare fraud statute. When a whistleblower contacts federal investigators, the government decides if it will intervene in the case. If it does, federal prosecutors will formally take over. If the government chooses not to intervene, the whistleblower can pursue the case alone. Whistleblowers who successfully bring a case, either on their own or after the government intervenes, are entitled to a percentage of the amount recovered. This raises some suspicion about the information whistleblowers provide. These suspect accusations should still be taken very seriously. If you are facing a whistleblower situation, contact an Orlando federal healthcare fraud defense attorney today.

Who investigates DEA opioid cases in Orlando, Florida?

 

Orlando is a hotspot for DEA opioid investigations. With instructions from Washington D.C., federal prosecutors and DEA Diversion Investigators in Florida monitor physicians’ offices. They attempt to identify the main prescribers of opioids, benzodiazepines, stimulants, sedatives, and muscle relaxants. The DEA is assisted by the DOJ, the U.S. Attorney’s Office, the OIG, the HHS, and the FBI.


Schedule a Free Case Assessment at Oberheiden, P.C.

For more information about our federal healthcare fraud defense team’s practice, please contact our Orlando healthcare fraud defense attorneys to schedule a confidential initial case assessment. You can reach us by phone 24/7 at 407-706-9203, or submit a confidential inquiry online and a member of our team will be in touch as soon as possible.

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