Riverside Healthcare Fraud Defense Lawyers
Established Riverside Healthcare Fraud Defense Attorneys
Healthcare providers in Riverside, CA, are targeted for prosecution by the Department of Justice (DOJ), Drug Enforcement Administration (DEA), Office of Inspector General (OIG), and other federal agencies. Have you received a target letter, subpoena, or any other form of contact from federal authorities? If so, it’s important to speak with our Riverside healthcare fraud defense lawyers, right away.
7121 Magnolia Avenue
Riverside, CA 92504
As a healthcare provider, one of the greatest threats to your practice is the prosecution for healthcare fraud. Agencies like the DOJ, DEA, and OIG target healthcare providers. Investigations focused on securing evidence to pursue civil or criminal charges are a real threat.
If your healthcare practice or business is under investigation, what do you need to know? What do you need to do? What mistakes do you need to avoid? What are the chances you could face conviction at trial? These are all critical questions with no easy answers. At Oberheiden, P.C., our team have combined legal experience. We can use this experience to protect you against avoidable consequences in California.
When you defend yourself against the federal government, everything you say and do can lead to negative outcomes. With their resources and legal mandates, federal agencies aggressively prosecute healthcare providers. Our team of highly experienced defense attorneys and former federal healthcare fraud prosecutors can help level the playing field. We use the knowledge and insights from thousands of cases to help secure a favorable outcome.
What Is Healthcare Fraud?
If federal authorities contact you, or any member of your business or practice, you know you’re under investigation. But, that’s only part of the story. “Healthcare fraud” is a broad term with various connotations. To defend your livelihood, you need a clear view of the allegations against you. Depending on the nature of your business or practice, the state of your billing compliance program, and various other factors, allegations could include:
- Medicare, Medicaid, or Tricare coding errors (which may be classified as “billing fraud”)
- Department of Labor (DOL) fraud
- Anti-Kickback Statute violations (i.e., unlawful “kickbacks” or referral fees)
- Stark Law violations (i.e., unlawful physician “self-referrals”)
- Controlled Substances Act or DEA registration violations (i.e., prescription drug fraud)
- Providing and billing for medically-unnecessary services
- Billing for services not actually rendered to patients
- Falsifying patient records, prescriptions, physician certifications, or election statements
When you hire Oberheiden, P.C. to represent you, we work quickly to identify the specific types of “healthcare fraud” under investigation. We intervene in the investigation to make contact with federal agents and prosecutors handling the matter to gain information such as:
- What triggered the investigation?
- Which agencies and task forces are involved?
- Is anyone else under investigation?
- Is the investigation currently civil or criminal in nature?
- What evidence has the government collected to date?
When our Riverside healthcare fraud defense attorneys know what you are up against, we shift our focus to developing a strategy to resolve the situation before charges are filed.
1. The False Claims Act
Under the False Claims Act (FCA) healthcare providers can be prosecuted for both intentional and unintentional submission of “false or fraudulent” claims. Unintentional violations carry the potential for substantial monetary fines. Criminal violations carry fines and up to five years in prison for each offense. Financial penalties apply on a “per-claim” basis. Total liability in an FCA case can easily reach six or seven figures.
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) bars offering, paying, soliciting, or receiving referral fees or other goods and services in connection with federal healthcare benefit program referrals. This includes referrals for beneficiaries of Medicare, Medicaid, Tricare, and the DOL. The Anti-Kickback Statute includes provisions for both civil and criminal prosecution. It carries penalties similar to those imposed under the False Claims Act.
3. The Stark Law
The Stark Law prohibits physicians who participate in Medicare and Medicaid from engaging in so-called “self-referrals”. A self-referral is a referral for program-reimbursed business provided to (or received from) a related entity. The Stark Law is a civil statute. Potential penalties include recoupments, civil monetary penalties, treble damages, and permanent loss of Medicare or Medicaid participation.
4. The Controlled Substances Act
The Controlled Substances Act carries criminal penalties for:
- Fraudulent prescription practices,
- Drug diversion,
- Improper filling of prescriptions, and other forms of pharmaceutical fraud.
Providers who violate the Controlled Substances Act can have their DEA registrations revoked. They can also face criminal prosecution in federal district court. The CSA also provides the source of authority for the DEA’s registration program for providers who prescribe, administer, and dispense controlled substance medications. Note that the DEA routinely audits and investigates both registered and unregistered providers.
5. The Federal 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.” Under 18 U.S.C. 1347, potential penalties include criminal fines and federal imprisonment for up to 10 years, in most cases. However, if a violation results in serious bodily injury or death, prosecutors can seek 20 years to life behind bars.
6. Program Billing Regulations
Medicare, Medicaid, Tricare, and DOL billing regulations are the bane of many healthcare providers’ existence. Compliance is difficult and expensive. Even minor flaws in providers’ compliance programs can lead to significant negative outcomes. Violations of program billing regulations are the impetus for many investigations under the False Claims Act and 18 U.S.C. 1347.
7. Other Federal Criminal Statutes
In addition to these statutes, in criminal healthcare fraud cases, prosecutors with the U.S. Attorney’s Office often file charges for a number of other statutory offenses. These include:
- 18 U.S.C. 371 (criminal conspiracy)
- 18 U.S.C. 1028A (identity theft)
- 18 U.S.C. 1341 (mail fraud)
- 18 U.S.C. 1343 (wire fraud)
- 18 U.S.C. 1344 (bank fraud)
- 18 U.S.C. 1357 (money laundering)
- 21 U.S.C. 841 (distribution of controlled substances)
- 26 U.S.C. 7206 (tax fraud)
5 Reasons to Choose Oberheiden, P.C.’s Federal Healthcare Fraud Defense Team in Riverside, CA
With the risks involved, healthcare providers targeted in federal healthcare fraud investigations must defend themselves. They must keep their long-term best interests in mind. Here are five reasons why providers trust Oberheiden, P.C.’s Riverside healthcare fraud defense lawyer:
- Federal Prosecutorial Experience. Several of our attorneys are former federal prosecutors with experience in high-stakes cases involving the DOJ, DEA, OIG, and other federal law enforcement agencies.
- Thousands of Investigations and Hundreds of Trials Handled. Our Riverside healthcare fraud defense attorneys have collectively represented clients in thousands of federal investigations and hundreds of criminal trials.
- Record of Favorable Resolutions Prior to Indictment. Our Riverside healthcare fraud defense legal team has an extensive trial record. However, we emphasize securing favorable resolutions for our clients prior to charges being filed. We have helped more than 90% of our clients avoid criminal charges.
- Aggressive Pretrial and Trial Representation. If charges are certain, we will do everything possible to protect you against a guilty verdict. Our Riverside healthcare fraud defense lawyers work as a team to present a complete and cohesive defense. We leave no room for doubt as to what constitutes a just outcome.
- Customized, Personal, and Professional Legal Representation. We represent clients with the level of personalization and professionalism they expect and deserve. We want you to feel 100% confident knowing that Oberheiden, P.C.’s defense team is on your side.
Frequently Asked Questions
Are whistleblower complaints taken seriously?
Absolutely. There is some inherent suspicion that arises when someone brings a qui tam claim under the False Claims Act. The claimant stands to receive a portion of the amount recovered, and investigators take these claims seriously. Remember that even if the federal government does not get involved in the case, the whistleblower can continue on their own. No matter why you are investigated, it is crucial to contact a Riverside, CA federal healthcare fraud defense attorney as soon as possible.
Which federal agencies are in charge of investigating healthcare fraud in Riverside?
The complexity of federal healthcare fraud laws shows in the government’s enforcement structure. The FBI is primarily responsible for exploring claims of healthcare fraud. However, the FBI often cooperates with other federal agencies. If the FBI, OIG, DEA or other federal agency contacts you for information, assume you are under investigation. Then, you must take necessary precautions. The most important thing to know is that anything you say to an investigator can be used against you later. It’s best to avoid speaking with a federal agent or investigator until you first consult a California federal healthcare fraud defense attorney. An attorney can help you understand the nature of the investigation, and how to minimize your risk.
Should I speak with federal investigators about an investigation?
Absolutely not, at least not without first speaking to a Riverside federal healthcare fraud defense attorney. The problem with speaking to federal investigators is that you can never be sure whether they are being upfront with you about the investigation. You also won’t know who else they’ve spoken to. It’s easy to accidentally provide incomplete or misleading information to an investigator. That may well shift the focus to you. Rather than risk speaking with investigators on your own, the better option is to discuss the situation with an experienced California federal healthcare fraud defense attorney. This will help determine the best course of action.
Schedule a Free and Confidential Case Assessment at Oberheiden, P.C.
If you are facing a federal healthcare fraud investigation contact our Riverside healthcare fraud defense attorney at Oberheiden, P.C., to schedule a free initial case assessment. To speak with a senior attorney on our federal healthcare fraud defense team in confidence, call 888-680-1745 or tell us how to reach you online, now.