Salt Lake City, Utah Federal Healthcare Fraud Investigation Defense Attorneys
50 West Broadway Suite 300
Salt Lake City, UT 84101
Federal agents and prosecutors with the Federal Bureau of Investigation (FBI), the Drug Enforcement Administration (DEA), the U.S. Department of Justice (DOJ), and other law enforcement authorities have increased their prosecutions of providers suspected of healthcare fraud. For Utah physicians and business owners, this means it’s important to carefully reassess compliance efforts and to seek advise by experienced attorneys in the event of a federal investigation.
At Oberheiden, P.C., we represent healthcare providers in Salt Lake City and throughout Utah in health fraud investigations and prosecutions. Our attorneys are highly experienced – both in private practice and as former federal healthcare fraud prosecutors. What makes Oberheiden, P.C. different is our record of resolving healthcare fraud cases with neither civil, nor criminal liability for many of our clients.
Experienced Defense Attorneys for Healthcare Entities in Salt Lake City, Utah
When you hire Oberheiden, P.C., you will be represented by former Department of Justice officials and seasoned attorneys with significant experience in healthcare law matters. Salt Lake City healthcare fraud defense attorneys at Oberheiden, P.C. represent clients in Salt Lake City and surrounding communities who are under audit, investigation, or subject to prosecution for alleged healthcare fraud. Our team features:
- Former Department of Justice Trial Attorneys
- Former Assistant United States Attorneys
- Former Federal Healthcare Fraud Prosecutors
- Experience of More than 2,000 Healthcare Fraud Investigations
Strategic Legal Defense for All Healthcare Fraud Matters in Salt Lake City, Utah
Our attorneys are prepared to represent Utah physicians and healthcare executives in cases involving allegations of:
- Medicare and Medicaid fraud (18 U.S.C. 1347),
- 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).
“Trustworthy attorney who also understands the compliance, legal and business aspects of our group”
“Our companies have worked with firms all over the country within various specialties and now use [Oberheiden, P.C.] almost exclusively. Nick represented our companies in some federal law investigations. His guidance and expertise allowed us to continue to concentrate on our core business as he dealt with the complex legal issues.” – Satisfied Client
“Our experience with [Oberheiden, P.C.] was overwhelmingly positive! We recently brought a range of complex legal issues to the table, which they responded to with a systematic, prudent approach. Throughout our work together, Oberheiden, P.C. served as an invaluable source of practical guidance and legal leadership. We would recommend them highly and without reservation . . . .” – Satisfied Client
- Prescription Drug Fraud. Salt Lake City physicians who prescribe Schedule I, II or III drugs are targets of the DOJ and the DEA because of Utah’s opioid fatalities. Providers in Salt Lake City and surrounding communities need experienced attorneys for advice on how to avoid becoming accused of misusing prescribing authority the government considers illegal (21 U.S.C. 841, 21 U.S.C. 846). Physicians already under such allegations should not allow the government to continue building its case. They must take proactive measures and have experienced healthcare fraud defense attorneys help execute a strategic defense plan.
- Medicare Fraud, Medicaid Fraud. Medicare and Medicaid Fraud are among the most charged offenses in healthcare investigations. These types of fraud refer to the receipt of fraudulent payment from the Centers for Medicare and Medicaid Services (CMS). It could be that the applied code was improper or the services billed were actually not provided, 18 U.S.C. 1347. Classic areas of Medicare fraud investigations are:
- Home health agencies,
- Hospice agencies,
- Toxicology labs, and
- Physicians who certify and recertify need for Medicare services.
Oberheiden, P.C. has a history of resolving Medicare and Medicaid fraud investigations with no civil and no criminal liability for our clients. Call us today and find out how to protect your business, your license, and your livelihood.
- 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 by analyzing claims data and medical records. Often, this involves a statistical sampling of files in order 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 DOJ healthcare prosecutors with first-hand knowledge of the process lead our clients through the audit. They make sure they can continue their business and not worry about their license or government intervention.
- Illegal Kickbacks, Bribes, and Referral Fees. The Anti-Kickback Statute (AKS) prohibits the offer, solicitation, payment, or receipt of any form of compensation for a patient referral. The Anti-Kickback Statute is broad and covers any person, not just physicians, and any form of payment. Indirect schemes like “consulting arrangements” are also covered. Oberheiden, P.C. intervenes in Anti-Kickback violations by explaining that alleged payments fall under a statute exception. AKS investigations can quickly turn into criminal felony cases. Our case work shows it’s critical to contact experienced attorneys the moment you know your business may be in jeopardy. We offer a forceful defense to Utah businesses based on vast experience in Anti-Kickback cases. Call today to hear how we can turn your case around.
- False and Fraudulent Claims. The False Claims Act (FCA) is among the most widely enforced healthcare law statutes in Salt Lake City. The FCA is a hybrid statute, which means violations can carry both civil and criminal penalties. The FCA bars submission of “false and fraudulent” claims to Medicare, Medicaid, Tricare, and other government benefit programs. Any “false” submission for payment, even unintentional, can put you in danger of recoupments and heavy fines. Our firm has successfully handled FCA investigations across the country. We do this by offering clients proven defense strategies and compelling negotiation skills. Call us today if you received an OIG subpoena or other notice of a False Claims Act investigation against you or your business.
- Illegal Physician “Self-Referrals”. Utah physicians are frequently accused of violating federal Stark Law. The federal Stark Law imposes penalties for what are commonly known as physician “self-referrals.” Prohibited is referring certain federal healthcare program recipients to entities in which the 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. Oberheiden, P.C. has extensive experience in Stark Law matters. On a national basis, we have resolved Stark Law cases by avoiding any fines or recoupments for our clients. Call us today to find out how.
The attorneys at Oberheiden, P.C. are available to discuss your concerns or situation in a free and confidential consultation. Give us a call, you have nothing to lose. Speak to one of our former Department of Justice healthcare prosecutors today and find out how we assess your case. Get reliable guidance from experienced attorneys with a history of successful wins.
Utah Healthcare Fraud Investigations: Answers to Frequently-Asked Questions (FAQs)
Q: What should I do if my healthcare business or practice is under investigation?
If your Salt Lake City, Utah business or practice is under investigation by the federal government, we recommend these steps to eliminate the need for the government to continue its case:
- Extensive internal assessment by outside professionals. This should focus on identifying and resolving potential compliance issues—before the government reveals them.
- Enforcing your compliance efforts to demonstrate to the investigating authorities that you have no intent to violate the law.
- Engaging experienced attorneys to intervene and advise you in responding to the government’s inquiry.
- Executing a custom defense strategy focused on the scope of the investigation and the relevant facts at hand.
Q: What are the requirements for a valid physician certification for home healthcare?
Under federal regulations, in order to qualify for Medicare coverage, a home health patient must receive an in-person assessment from a Utah physician who certifies that the beneficiary is:
- Confined to the home;
- In need of skilled services;
- Under the care of a physician; and,
- Receiving services under a physician-reviewed care plan.
The in-person assessment must occur no earlier than 90 days prior to the commencement of home health services and no later than 30 days after services begin. Home health patients must also receive re-certification every 60 days.
Q: What are the potential consequences of a federal healthcare fraud investigation in Utah?
It is no secret that healthcare fraud statutes contain brutal consequences if found in violation. The exact outcome depends on:
- If the investigation is civil or criminal in nature,
- The scope of the government inquiry,
- The alleged damage amount suffered by the government,
- The volume and duration of alleged illegal activity,
- The available evidence, and
- The findings of criminal intent.
On a case-by-case basis, the penalties for federal healthcare fraud can include:
- Recoupments and denial of future claims
- Fines imposed on a per-claim basis
- Treble (triple) damages
- Loss of Medicare, Medicaid, and Tricare eligibility (program exclusion)
- Professional licensing action
- Loss of assignment privileges
- Loss of hospital privileges
- Long-term federal imprisonment
Contact Oberheiden, P.C. for a Complimentary Case Assessment
If you have concerns about your practice or if you are under investigation in Salt Lake City, Utah, we urge you to speak to us today. The sooner an experienced healthcare fraud defense attorney can intervene and take action, the more likely it is for us to resolve the matter before it gets out of hand. We take you and your case seriously We offer complimentary case assessments, so call 888-680-1745or contact us online to schedule a risk-free appointment now.
Areas We Serve in Salt Lake City, Utah
Subject to our terms and conditions and in accordance with the applicable local rules of 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: Salt Lake City, Provo, Alpine, American Fork, Beaver, Bluffdale, Bountiful, Brigham City, Cedar City, Centerville, Clearfield, Clinton, Cottonwood Heights, Draper, Eagle Mountain, Ephraim, Farmington, Grantsville, Heber City, Herriman, Highland, Holladay, Hurricane, Kaysville, Layton, Lehi, Logan, Midvale, Murray, North Ogden, Ogden, Orem, Payson, Pleasant Grove, Riverton, Roy, St. George, Sandy, Saratoga Springs, South Jordan, South Ogden, South Salt Lake, Springville, Syracuse, Spanish Fork, Taylorsville, Tooele, Washington, West Jordan, West Valley City, Woods Cross.
Compliance – Litigation – Defense
Serving the State of Utah and Surrounding Areas