Philadelphia Healthcare Fraud Lawyers & Defense Attorneys
Healthcare Providers and Business Owners in Philadelphia are Being Targeted in Federal Investigations
1515 Market Street Suite 1200
Philadelphia, PA 19102
Medical industry providers should understand the seriousness of healthcare fraud prosecutions in Philadelphia, Pennsylvania and surrounding communities. Several federal agencies seek to prosecute alleged fraud found in prescription policies, billing practices, and kickback agreements. In this climate of suspicion, being proactive is the best advice any lawyer may provide. Surround yourself with lawyers, like those from Oberheiden, P.C., who have the experience and history of resolving healthcare audits, investigations, and prosecutions. These resolutions often result in neither civil, nor criminal liability outcomes for our clients. Here are the areas most likely targeted in Philadelphia and surrounding locations:
- Healthcare businesses,
- Medical practices,
- Home health and hospice agencies,
- Durable medical equipment (DME) companies.
What is Healthcare Fraud?
In broad terms, Philadelphia federal authorities seek to eliminate “healthcare fraud.” Healthcare fraud means a variety of offenses, some are criminal in nature while others are civil. All federal healthcare fraud statutes have penalties for wrongdoing that can be served. Some charges may even include criminal prosecution. Frequent fraud charges against Philadelphia providers include:
- Medicare and Medicaid Fraud (18 U.S.C. 1347),
- Controlled Substances Act (21 U.S.C. 841),
- Anti-Kickback Statute (42 U.S.C. 1320a-7b),
- Stark Law Statute (42 U.S.C. 1395nn), and
- False Claims Act (31 U.S.C. 3729-3733).
Philadelphia Healthcare Fraud Lawyers Helping You in Investigations
Oberheiden, P.C. is a team of experienced defense attorneys with a record of successfully representing clients in Philadelphia, and nationwide. We provide counsel in healthcare fraud audits, investigations, and prosecutions. Our healthcare fraud attorneys include several former prosecutors who held senior-level positions within the U.S. Attorney’s Office and the Department of Justice. Each of our attorneys has first-hand knowledge and specific background in healthcare cases. Together with our clients, we identify the proper strategy based on the details of each case. Our experience includes:
- More than 2,000 healthcare fraud investigations
- Dismissal of state and federal indictments
- More than 70 combined years of Department of Justice experience
If there are options to help you limit or avoid liability, we will use them, so you won’t face unjust penalties. From justifying your Medicare billings to asserting safe harbor protections of the Anti-Kickback Statute or the Stark Law, we will do our utmost to achieve the best possible outcome.
Highly Experienced With Audits and on Both Sides of Civil and Criminal Healthcare Fraud Investigations
If your Philadelphia business or practice is a target for audit or investigation, we encourage you to contact us promptly for a free case assessment. One of the reasons Oberheiden, P.C. resolves so many healthcare fraud cases successfully is our proactive approach. We work to aggressively intervene and stop the investigation before it expands. Our attorneys communicate with auditors, agents, and prosecutors to protect your license, livelihood, and freedom. We represent medical providers and companies facing allegations such as:
- Prescription Drug Fraud. The Justice Department has increased its investigation of pain medicine-prescribing physicians. It is essential to make sure your practice is in full compliance with the Controlled Substances Act and other drug diversion statutes. Note that prescription fraud cases are federal criminal prosecutions. Clients approached by law enforcement should quickly contact experienced lawyers to protect their rights. Oberheiden, P.C. is at the forefront of defending physicians in Philadelphia and surrounding communities against unjust accusations of fraud and diversion.
- Medicare Audits. There are several types of Medicare audits. Medicare Administrative Contractors (MACs) and Recovery Audit Contractors (RACs) work to identify improper payments by analyzing claims data and medical records. Many times this involves a statistical sampling of files to establish an error rate. Another type of Medicare audit is conducted by Zone Program Integrity Contractors (ZPICs). ZPIC audits identify potential fraud and refer cases to the Department of Health and Human Services (HHS) and the Office of Inspector General (OIG). The risk with Medicare audits is that if mishandled, they can lead to referrals to the U.S. Attorney’s Office. Oberheiden, P.C. knows how to avoid such a referral. Former Department of Justice healthcare prosecutors with first-hand knowledge of the process lead our clients through the audit. They ensure clients can continue their business and not worry about their license or government intervention.
- False Medical Claims. The False Claims Act (FCA) is a federal statute that contains civil and criminal penalties for healthcare providers who submit “false and fraudulent” claims for federal health program payment. Investigations under the FCA require professional expertise because the law does not require intent or actual knowledge of the falseness of the claims. The mere submission of a false claim (e.g. by applying the wrong code) is enough to subject your practice to enormous fines ranging from $11,000 per claim to treble damages and more. Worse, if the case is not handled with care, a referral for criminal prosecution is possible.
- Anti-Kickback Statute Violations. Under this Statute, it is illegal to “knowingly and willfully” offer, pay, solicit, or receive “any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind,” in exchange for a patient referral. Like the False Claims Act, the Anti-Kickback Statute provides for both civil and criminal penalties. When facing kickback violations, it is important to counter the government with a recognized and experienced defense team from the beginning. Oberheiden, P.C. has concluded many kickback investigations with no civil or criminal liability for our clients. We are delighted to do the same for you.
- Stark Law Violations. The federal Stark Law imposes penalties for what are commonly known as physician “self-referrals.” Physicians are prohibited from referring certain federal healthcare program beneficiaries to entities in which these referring physicians have a financial interest. Liability costs under the Stark Law statute can be massive. Similar to the Anti-Kickback Statute, the Stark Law includes various exceptions, and Oberheiden, P.C. has a record of identifying these exceptions to protect our clients from liability.
- Billing Fraud. Billing fraud is a form of healthcare fraud that commonly leads to charges under the False Claims Act. The submission of any improper payment request Medicare, Medicaid, Tricare, or other federal benefits program can result in liability. Federal investigators and prosecutors routinely pursue cases based on allegations of:
- Phantom billing,
- Billing for medically-unnecessary services, and
- Other billing and coding violations.
- Home Health & Hospice Agency Fraud. Home health providers and Medicare businesses in Philadelphia depend on physician certifications to qualify for service reimbursement under Medicare rules. On the other side, government agents try hard to discredit the doctors and the agencies by claiming fraudulent certifications and re-certifications. Oberheiden, P.C. has had great success representing medical providers and agencies against government investigations. To find out how, call our team of senior attorneys today for a free and confidential case assessment.
Answers to FAQs: Defending Against Healthcare Fraud Investigations in Philadelphia
Q: Why is my healthcare business or medical practice being investigated?
- Receiving an unfavorable determination in a RAC, MAC, or ZPIC audit
- Having billing records that are inconsistent with those of other local providers (even if there is clear justification based on the unique aspects of your business or practice)
- Being targeted in a whistleblower (or qui tam) complaint
Q: What are some potential defenses to healthcare fraud allegations?
- Claiming statutory safe harbors and exceptions
- Asserting Constitutional protections
- Challenging the government’s case for lack of intent
- Using your billing or patient records to demonstrate compliance with the law
Q: What outcomes can I reasonably expect from my investigation?
Contact Us Now for a Free Case Assessment
At Oberheiden, P.C., every engagement begins with a free case assessment. When you contact us, we will arrange for you to meet with our healthcare fraud defense team right away. If you decide to move forward, we will intervene immediately. We will work closely with you and your key personnel to implement a defense strategy that is customized to your situation. The easiest thing in the entire process is to make a phone call. Call 888-680-1745 from Philadelphia, PA or request an appointment online and we will be in touch as soon as possible.
Areas We Serve in Philadelphia, PA
Subject to our terms and conditions and in accordance with the applicable local rules of the United States District Courts and state professional boards, the attorneys of Oberheiden, P.C. may accept engagements in federal cases relating to the following geographical areas either as already admitted counsel, pro hac vice, or in combination with locally licensed counsel. The areas include: Philadelphia, Chestnut Hill, Camden, Gloucester City, Yeadon, Collingswood, Darby, Pennsauken, Lansdowne, Audubon, Drexel Hill, Bellmawr, Cherry Hill, Haddonfield, Woodbury, Springfield, Manayunk, Mt. Airy, Bristol, Doylestown, New Hope, Kennett Square, Phoenixville, West Chester, Media, Wayne, Ambler, Ardmore, Jenkintown, Skippack, Bethlehem, Bryan Athyn.