Experienced Healthcare Fraud Defense Lawyers Serving Pittsburgh, Pennsylvania
Compliance – Litigation – Defense
First announced in 2017, the Department of Justice currently expends enormous resources to identify and prosecute healthcare fraud in Pittsburgh and surrounding communities. If you are:
- A physician, or own
- A healthcare practice,
- A pharmacy,
- A hospital,
- A toxicology lab,
- A hospice company, or
- A home healthcare business, you may be at risk for federal healthcare fraud investigations. It’s time to seek reliable legal advice!
429 Fourth Ave. Suite 300
Pittsburgh, PA 15219
Defending Against Healthcare Fraud Investigations and Charges in Pittsburgh, PA
Oberheiden, P.C. is a team of former Department of Justice trial attorneys, federal prosecutors, and seasoned defense attorneys with significant experience in healthcare matters. Many of our attorneys served as federal healthcare fraud prosecutors at various U.S. Attorneys’ Offices. They offer clients valuable information when it comes to civil and criminal fraud investigations.
Most of our clients are shocked when they learn their business is under audit, let alone under investigation, for federal fraud allegations. When this happens, there is no time to hesitate. Consult with an experienced health care fraud attorney from our firm and find out how we can help with your situation. Our experience includes:
- More than 2,000 healthcare fraud investigations
- More than 2,000 grand jury investigations
- Dismissal of state and federal indictments
- More than 70 combined years of DOJ experience
Our attorneys have successfully represented medical professionals in a great variety of areas against alleged violations. We have ample knowledge of the Controlled Substances Act, Medicare, and Medicaid Fraud, the Anti-Kickback Statute, and fraud of private insurance plans. Call us today if you have concerns about your situation or if you are under investigation. As we have for many others, we will find a way to protect and defend you. We are proud of our long and distinct healthcare fraud defense history of obtaining favorable outcomes during investigations and, when necessary, at trial.
Common Allegations in Pittsburgh Federal Healthcare Fraud Matters
Healthcare fraud audits and investigations in Pittsburgh focus on Medicare Fraud (18 U.S.C. 1347), Medicaid Fraud, as well as violations of the Controlled Substances Act (21 U.S.C. 841), the Anti-Kickback Statute (42 U.S.C. 1320a-7b), the Stark Law Statute (42 U.S.C. 1395nn), and the federal False Claims Act (31 U.S.C. 3729-3733).
- Opioids and Narcotic Diversion. In late 2017, the Attorney General of the United States instructed all federal prosecutors to identify and charge narcotic prescribing physicians who fall under the Justice Department’s definition of “pill mill” operators. Pain management doctors in Pittsburgh should realize the increased scrutiny and the risks of prescribing scheduled drugs. In this climate of investigations, Pittsburgh doctors and pharmacies must ask an important question. Do I risk being the next target, or do I seek professional guidance to protect and defend me?
- Healthcare Fraud and Conspiracy. In criminal healthcare fraud cases, government prosecutors typically charge the general healthcare fraud statute. In cases with multiple defendants, a conspiracy to commit healthcare fraud may be charged instead. Title 18 U.S.C. Sect. 1347 reads as follows:
Whoever knowingly or willfully executes or attempts to execute a scheme to defraud any healthcare benefit program or 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 in connection with the delivery of or payment for healthcare benefits, items, or services, shall be fined or imprisoned of up to 10 years, or both.
Oberheiden, P.C. has a record of avoiding and defending healthcare fraud charges for clients across the country. Our clients in Pennsylvania have the experience that they can trust our expertise and we want to do the same for you and your business.
- Anti-Kickback Statute. This statute prohibits knowingly soliciting, paying, and/or accepting any form of payment to induce or reward referrals for items or services reimbursed by federal healthcare programs. See, 42 U.S.C. 1320A-7b(b). Oberheiden, P.C. explains to government lawyers how clients accused of Anti-Kickback violations have in fact operated lawfully under one of the many exceptions in the statute. If you are notified of an Anti-Kickback allegation, a mistake in your defense strategy can mean criminal prosecution and the attached penalties. Contact Oberheiden, P.C. before charges are filed.
- Medicare Audits. There are several types of Medicare audits. In general, Medicare Administrative Contractors (MACs) and Recovery Audit Contractors (RACs) work to identify improper payments through a process of analyzing claims data and medical records. Many times this involves a statistical sampling of files in order to establish an error rate. Another type of Medicare audit is conducted by the 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, it can lead to a referral to the U.S. Attorney’s Office. Oberheiden, P.C. knows how to avoid this. Former Department of Justice healthcare prosecutors with first-hand knowledge of the process lead our clients through the audit. They make sure clients can continue their business and not worry about their license or a government intervention.
- False Claims Act. Oberheiden, P.C. has a history of managing False Claims Act audits and prosecutions resulting in neither civil, nor criminal penalties for our clients. The federal False Claims Act applies whenever a false claim is submitted to a federal healthcare program. A typical example is a claim submitted and paid for a more costly procedure than the one actually performed for the patient. The federal False Claims Act can trigger a civil investigation (see, 31 U.S.C. Sect. 3729-3733) but it also authorizes the government to seek criminal prosecution (see, 18 U.S.C. Sect. 287). Don’t let this happen to your business!
Oberheiden, P.C. has successfully defended clients in healthcare audits, grand jury investigations, and healthcare fraud prosecutions in most areas of the United States. If you need help in Pittsburgh or other parts of Pennsylvania to fight the following allegations, contact Oberheiden, P.C. today for reliable legal counsel. Initial calls are free and confidential:
- Medicare Fraud,
- Medicaid Fraud,
- Tricare Fraud,
- False Claims Act violations,
- Qui Tam Defense,
- Stark Law Violations,
- Physician Self-Referrals,
- Controlled Substances Act violations.
FAQs: Defending Against Healthcare Fraud Allegations in Pittsburgh, PA
Q: What are the differences between civil and criminal healthcare fraud investigations?
The main difference between a civil and a criminal healthcare fraud investigation are the potential outcomes if the government can prove alleged fraud. In civil cases, the outcome could be a repayment or a fine. Criminal cases are very different. They carry the potential of felony conviction, program exclusion, license revocation, and prison time. Often, it is not entirely clear at the beginning of a case whether the matter is civil or criminal in nature. Experienced attorneys will be able to tell you quickly, however. When Oberheiden, P.C. represents a new client, one of our first tasks is to determine what type of exposure our client may have and how to minimize it.
Q: What steps are involved in defending against a federal healthcare fraud investigation?
The number one priority of Oberheiden, P.C. in federal healthcare fraud investigations is to intervene. Much of our record has to do with the fact that we don’t wait or hesitate to take action. We quickly contact the agent, the auditor, the prosecutor, and whoever else may be behind the fraud investigation and take a stand for our client. In general, our approach to defending Pittsburgh-area clients against fraud allegations involves:
- Early intervention in the investigation
- Establishing a dialogue with the investigators and prosecutors
- Conducting an internal assessment
- Developing and executing a tailored defense strategy
- Seeking to secure a favorable resolution before charges are filed
Speak with Our Healthcare Fraud Defense Lawyers in Confidence
If you are facing an audit or a federal healthcare fraud investigation in Pittsburgh, Pennsylvania, we encourage you to contact us today for a free and confidential case review. To speak with our healthcare fraud defense lawyers about your situation, please call 888-680-1745 or inquire online now.
“It is very clear to me that Nick Oberheiden has a deep understanding of health law issues. [He] has been instrumental in managing and resolving many difficult legal matters [and] is always relentlessly focused on the critical issues that matter most. Nick is very dedicated and . . . displays a high degree of professionalism. I would not hesitate in recommending Nick for the most important of legal matters.” – Satisfied Client
“I hired Nick Oberheiden and Oberheiden, P.C. to defend me in a criminal healthcare matter. From the first moment I met with Nick[,] my wife and I knew that he [would provide] the help I need[ed]. And yes, Nick got me out of trouble. No charges. Case Dismissed.” – Satisfied Client
Areas We Serve in Pittsburgh, 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: Pittsburgh, Dormont, Brentwood, Wilkinsburg, Munhall, Swissvale, Mount Lebanon, Baldwin, Neville Township, Bethel Park, West Mifflin, North Versailles, Franklin Park, Plum, Lower Burrell, New Kensington, Allegheny, Allentown, Arlington, Arlington Heights, Banksville, Bedford Dwellings, Beechview, Beltzhoover, Bloomfield, Bluff, Bon Air, Larimer, Lincoln-Lemington-Belmar, Homewood, Knoxville, Glen Hazel, Friendship, Esplen, East Carnegie, East Hills, Elliott, Fairywood, Fineview, Highland Park, Duquesne Heights, Crafton Heights, Chateau, Chartiers, Central Oakland, Central Northside, Mexican War Streets, Central Business District, Chinatown, Cultural District, Carrick, California-Kirkbride, Brookline, Lincoln Place, Mount Oliver, Shadyside, Regent Square, North Oakland, New Homestead, North Point Breeze, Morningside, Summer Hill, Spring Hill-City View, Saint Clair, Perry South, Oakwood, Overbrook, Terrace Village, Stanton Heights, Sheraden, Swisshelm Park, Duck Hollow, Troy Hill.
Compliance – Litigation – Defense
Serving the State of Pennsylvania and Surrounding Areas