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Sacramento Healthcare Fraud Defense Lawyer

Experienced Sacramento Healthcare Fraud Defense Attorneys

A federal healthcare fraud investigation can lead to recoupments, fines, program exclusion, prison time, and other penalties. If you have been contacted by federal agents in Sacramento, call 888-680-1745 to speak with one of our highly experienced Sacramento healthcare fraud defense lawyers immediately.

Sacramento address – by appointment only:
836 57th Street Suite 250
Sacramento, CA 95819
888-680-1745

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As a healthcare provider, meeting your patients’ needs is – and should be – your top priority. In today’s medical system many providers depend on funds from federal programs such as Medicare, Medicaid, and Tricare. An unfortunate reality is that patient care seems to lag behind federal legal and regulatory compliance.

Under federal laws such as the False Claims Act and the Anti-Kickback Statute, healthcare providers billing federal programs can face severe penalties for program violations. These providers are also subject to scrutiny by federal authorities. Most often, these are the agencies involved:

  • Department of Justice (DOJ),
  • Drug Enforcement Administration (DEA),
  • Office of Inspector General (OIG), and
  • Centers for Medicare and Medicaid Services (CMS).

Such monitoring often leads to invasive and potentially dangerous investigations. If your business or practice is under investigation, you must take the situation very seriously. You could be exposed to severe financial penalties, loss of program participation, loss of licensure and DEA registration, and even federal imprisonment.

Healthcare fraud defense law firm in Sacramento.At Oberheiden, P.C., we are devoted to helping healthcare providers against federal allegations in Sacramento and across the country. Our healthcare fraud defense team has handled thousands of investigations. The team includes senior healthcare fraud defense lawyers and former federal prosecutors. Our Sacramento healthcare fraud defense lawyers have helped the majority of our clients resolve their investigations with no charges filed. We also have extensive experience in pretrial, trial, and appellate litigation. Regardless of the status of your federal inquiry, we can use this experience to protect you.

Why Am I under Investigation for Healthcare Fraud?

Why have federal authorities chosen to single out your healthcare business or medical practice for investigation? While there are several potential triggers, most are the result of one of three factors:

  • Data analysis – Medicare, Medicaid, Tricare, and the Department of Labor (DOL) receive a huge number of claims on a daily basis. And, the government relies heavily on data analysis to identify fraudulent transactions. If your billings contrast with those of other Sacramento-area providers, it could trigger a federal investigation.
  • Citizen complaint – Patients, disgruntled former employees, and even competitors can file claims alleging fraud. In these qui tam (or “whistleblower”) lawsuits, the DOJ has an obligation to investigate. Citizens can receive sizable financial awards if their allegations lead to successful prosecution.
  • Routine audit or investigation – CMS, the DEA, and other agencies conduct routine audits and reviews of healthcare providers who bill federal government programs. But, even “routine” inquiries have the potential to lead to civil or criminal charges. Healthcare providers in Sacramento are at risk of unwanted federal attention as populous cities have a high number of healthcare providers. Investigations targeting larger providers in these cities can lead to sizable recoupments and fines for the government. We have seen an increase in federal investigations targeting providers in Sacramento, California and other cities for allegations such as:
    • Intentional or unintentional billing and coding errors (including, but not limited to, submitting an improper billing code and double-billing multiple programs and/or insurance carriers)
    • Billing for medically-unnecessary services
    • Billing for services that were not actually rendered
    • Offering, soliciting, paying, or accepting any illegal “kickback” or referral fee
    • Diverting prescription opioid medications
    • Selling, forging, or improperly filling prescriptions
    • Falsifying patient records, physician certifications, or election statements
    • Using any other “scheme or artifice” to obtain payment from Medicare, Medicaid, Tricare, or the DOL

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) prohibits the submission of any “false or fraudulent” claim for payment by the federal government. Each form of healthcare fraud listed above may be prosecuted as a federal offense under the FCA. The False Claims Act includes provisions for civil and criminal penalties. Providers accused of intentionally overbilling Medicare, Medicaid, Tricare, or the DOL must effectively challenge the government’s evidence of intent to avoid criminal sentencing.

2. The Anti-Kickback Statute

The Anti-Kickback Statute (AKS) 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 violations have in fact operated lawfully under one of the statute’s exceptions. If you are notified of an Anti-Kickback allegation, a mistake in your defense strategy can mean criminal prosecution. Contact Oberheiden, P.C. before charges are filed.

3. The Stark Law

The Stark Law is a civil statute that applies only to physicians and their “related entities.” It prohibits so-called “physician self-referrals”. Its scope is limited to the “designated health services” listed in the statute. Similar to the Anti-Kickback Statute, the Stark Law’s prohibitions are subject to a number of safe harbors and exceptions.

4. The Controlled Substances Act

The Controlled Substances Act (CSA) is one of the primary federal statutes used to prosecute providers for pharmaceutical fraud. This includes:

  • Forging prescriptions,
  • Prescribing medically-unnecessary drugs,
  • Improperly filling prescriptions, and
  • Failing to maintain compliance with the conditions of DEA registration.

The CSA’s criminal penalties are severe. Providers accused of prescription drug-related fraud crimes will need strategic and aggressive defenses. A robust defense can help avoid indictment, prosecution, conviction, and sentencing.

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.” 18 U.S.C. 1347 imposes severe criminal penalties as well. And in certain cases, healthcare providers can face the possibility of life behind bars.

6. Program Billing Regulations

Federal healthcare benefit programs have their own unique and complex set of governing rules and regulations. Failure to maintain strict compliance can lead to liability under the False Claims Act. There is also a potential for criminal prosecution under 18 U.S.C. 1347. Maintaining a thorough compliance program helps demonstrate good-faith efforts to comply. Maintaining compliance standards can also help disprove any allegations of intent. However, missteps by billing personnel and other staff members can still lead to potential exposure.

7. Other Federal Criminal Laws

In criminal healthcare fraud investigations, providers and company executives can face a variety of other charges including:

  • Conspiracy,
  • Bank fraud,
  • Mail fraud,
  • Wire fraud, and
  • Money laundering.

Those charged with such offenses can suffer millions of dollars in fines and decades of federal incarceration. Mounting a successful defense may present the only chance to avoid life-altering outcomes.

Frequently Asked Questions

What is a qui tam lawsuit?

 

The term “qui tam” refers to a whistleblower claim filed under the False Claims Act. The False Claims Act is unique among federal statutes in allowing a private citizen with knowledge of healthcare fraud to bring a case against a provider. Most often, the whistleblower first goes to the federal government with information. This lets the government decide if it will intervene in the case. If it does, the federal government takes over the investigation. If the federal government decides there are additional charges that apply, it may add them. In other words, the government is not bound by the exact claims brought by the whistleblower. If the federal government decides not to intervene, the whistleblower can continue the case on his/her own. Qui tam lawsuits are common. Likely, because whistleblowers can receive up to 30 percent of the amount recovered in a lawsuit. This may give whistleblowers too much incentive to come forward with what could be dubious evidence. If a whistleblower accuses you or your practice of healthcare fraud, speak to a Sacramento federal healthcare fraud defense attorney right away.

What can a Sacramento, California federal healthcare fraud defense attorney do to help me?

 

If you are a healthcare provider under investigation or audit by a federal agency, a California federal healthcare fraud defense attorney can help in many ways. The first step in any healthcare fraud defense case is determining if there is criminal exposure. If there is, everything possible must be done to eliminate it. While civil cases are still very serious, criminal cases carry the risk of prison time. A healthcare fraud defense attorney will also communicate with federal investigators to learn more about the allegations. From here, your attorney will conduct his/her own investigation, looking for weaknesses in the government’s case. For example, investigators may point to a few billing problems that don’t necessarily mean a wide-ranging fraud scheme.

What should I look for in a California federal healthcare fraud defense law firm?

 

There are many factors to take into account when hiring a California federal healthcare fraud defense attorney. Finding a lawyer with specific experience handling healthcare fraud cases is vital. Healthcare fraud cases are extremely complex and require a knowledge of the laws and the healthcare industry as a whole. These are not cases to be handled by any attorney. One with years of experience litigating other types of federal cases may not have the skills you need. If you are under investigation for healthcare fraud, you need an attorney who has represented hundreds of other clients in similar situations. Oberheiden, P.C. has former federal prosecutors and investigators on the team. This gives us a unique perspective into how the government builds its cases.


5 Reasons to Choose Oberheiden, P.C., for Your Federal Healthcare Fraud Investigation in Sacramento

Sacramento Healthcare Fraud Defense LawyerYou have been contacted by federal agents, received a target letter, or been served with a subpoena. What do you need to do now? While there are several steps to take (and mistakes to avoid), the most important thing you can do is retain an experienced defense team immediately. When you choose the healthcare fraud defense lawyers at Oberheiden, P.C.:

  • We will promptly intervene in the government’s investigation. This ensures your rights are protected and you have every available chance to secure a favorable resolution without charges filed.
  • We will execute a strategic and customized defense. We will customize your defense to the unique facts of your case. This allows us to strategically pursue all opportunities for a favorable resolution.
  • We will use our extensive experience to your advantage. As nationally recognized healthcare fraud defense attorneys and former federal healthcare fraud prosecutors, we have ample experience in high-stakes federal investigations.
  • We will constantly evaluate and re-evaluate our defense strategy. The best defense strategy today might not be the best defense strategy tomorrow. We will re-evaluate your options regularly to take advantage of new leverage as it becomes available.
  • We will be prepared to go to trial, if necessary. If going to court is your best option, our Sacramento healthcare fraud defense attorney will be fully prepared to fight for your freedom in court.

Contact Us About Your Federal Investigation in Sacramento

If you need legal representation for a federal healthcare fraud investigation, our Sacramento healthcare fraud defense attorneys encourage you to contact us promptly for a free initial case assessment. To speak with one of our highly experienced defense attorneys in confidence, call 888-680-1745 or request an appointment online now.

Additional Pages for Sacramento, California

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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