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San Francisco Healthcare Fraud Defense Attorneys

What do you need to know if your San Francisco healthcare practice or medical business is under investigation for fraud? Find out from the San Francisco federal healthcare fraud defense lawyers at Oberheiden, P.C. For a free and confidential case assessment, call 888-680-1745.

San Francisco address – by appointment only:
201 Spear Street Suite 1100
San Francisco, CA 94105

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For healthcare providers and others in the healthcare industry, federal fraud investigations can lead to devastating fallout. Laws such as the False Claims Act and Anti-Kickback Statute impose civil and criminal penalties for statutory violations. Physicians, pharmacists, company executives, and others targeted in these cases can face crippling financial penalties, loss of federal healthcare benefit program involvement, and even federal imprisonment.

At Oberheiden, P.C., our federal team is committed to protecting healthcare clients in federal fraud investigations in San Francisco, California and nationwide. Our healthcare fraud defense attorneys represent clients at all stages of the process. We strive to achieve a favorable outcome as quickly and cost-effectively as possible. Composed entirely of seasoned litigators, we represent clients under the most challenging of situations. We are on your side when the most severe penalties are on the table.

Your business or practice is under investigation for healthcare fraud. What now? Knowing that you are at risk for serious outcomes, your first step must be engaging the right legal counsel. At Oberheiden, P.C., our San Francisco federal healthcare fraud defense attorneys are available 24/7. We can arrange for you to meet with a member of our team over the phone or in person as soon as possible.

What Is Healthcare Fraud?

What comes to mind when you think about “healthcare fraud”? For many, the term calls up thoughts of scam artists who are more interested in gaming the system than helping patients. This is one example, but even legitimate and prominent healthcare providers get caught up in federal healthcare fraud inquiries. The government’s reliance on billing data and claims from whistleblowers leaves a provider’s reputation meaningless when named the target of fraud allegations.

A common mistake about healthcare fraud is, in order to be liable, you must purposely seek to defraud the government. Intent is a factor in criminal prosecutions under the False Claims Act, Anti-Kickback Statute, and other federal healthcare laws. Evidence of intent, however, is not necessary to establish liability for civil healthcare fraud. Providers who try to maintain good billing compliance programs can still face liability for “fraudulent” billing practices.
Following are some examples of actions that can carry civil liability even if there was no intention to commit fraud:

  • Improperly prescribing, providing, or dispensing prescription medications
  • Offering, paying, soliciting, or accepting an illegal kickback or referral fee
  • Unintentionally overbilling Medicare, Medicaid, Tricare, or the Department of Labor (DOL) healthcare benefit program
  • Unintentionally billing Medicare, Medicaid, Tricare, or the DOL for medically-unnecessary services or supplies
  • Unintentionally billing Medicare, Medicaid, Tricare, or the DOL for services or supplies not actually rendered to patients
  • Violating the standards for maintenance of patient records and election statements or for issuing prescriptions or physician certifications

Do you know why your healthcare practice or business is under investigation? At this point, even if you think you know why your practice or business is a target, the answer needs to be a resounding, “No.”

Until you have details about the government’s case, the simple fact is you don’t know why you are being targeted. To defend yourself, you need to know what the government knows, or thinks it knows. Our attorneys have experience on both sides of federal investigations. This allows us to take the steps necessary to promptly intervene in your case. Our intervention lets us determine if there are civil or criminal charges against you.

Put our highly experienced team on your side

Dr. Nick Oberheiden
Dr. Nick Oberheiden



Lynette S. Byrd
Lynette S. Byrd

Former DOJ Trial Attorney


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. This includes improper billings submitted to Medicare, Medicaid, Tricare, and the DOL. Civil penalties under the FCA include fines, recoupments, treble damages, and program exclusion. Providers, executives, board members, and others receiving criminal charges, can face financial penalties and federal prison time.

2. The Anti-Kickback Statute

The Anti-Kickback Statute (AKS) bars healthcare providers from offering, paying, soliciting, or receiving referral fees or other forms of payment in connection with Medicare, Medicaid, Tricare, and DOL referrals. Anti-Kickback Statute inquiries often target providers and other entities that offer or solicit illegal payments. However, simply accepting an improper payment, even without bad intent, is enough to trigger AKS liability.

3. The Stark Law

The Stark Law prohibits improper payments between physicians and their related entities. This activity is also known as “physician self-referrals.” The Stark Law imposes civil penalties similar to the False Claims Act. Unlike several other laws, the Stark Law does not carry criminal penalties. However, those who intentionally engage in improper referrals involving funds paid by federal programs can face charges under other statutes.

4. The Controlled Substances Act (CSA)

The Controlled Substances Act (CSA) is the primary statute used to investigate and prosecute providers for prescription drug fraud. Other prescription drug related offenses are covered in the Act as well. The CSA oversees the federal registration system for providers who administer, prescribe, and dispense controlled medications. Providers whose practices involve prescription drugs can face both routine and non-routine investigations.

5. The Federal Healthcare Fraud Statute

The healthcare fraud statute, 18 U.S.C. 1347, makes it a federal offense to “knowingly and willfully . . . (1) . . . defraud [or attempt to defraud] any healthcare benefit program; or (2) . . . obtain [or attempt 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.” Violations of 18 U.S.C. 1347 carry penalties that include fines and prison sentences ranging from 10 years to life behind bars.

6. Program Billing Regulations

Medicare, Medicaid, Tricare, and DOL billing regulations are very complex, and they are the focus of many federal healthcare fraud cases. Program participants who violate the applicable regulations can face charges under the False Claims Act, 18 U.S.C. 1347, and other federal civil and criminal statutes.

7. Other Federal Criminal Statutes

Healthcare providers, entities, and others targeted in fraud probes can face charges under several other criminal statutes. These charges are all common in criminal federal healthcare fraud prosecutions:

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

5 Reasons to Choose Oberheiden, P.C.’s Defense Lawyers for Your Federal Healthcare Fraud Investigation in San Francisco

San Francisco Healthcare Fraud Defense AttorneysIf you, or someone within your business or practice, has been contacted by: the Department of Justice (DOJ), the Drug Enforcement Administration (DEA), the Federal Bureau of Investigation (FBI), the Internal Revenue Service (IRS), the Office of Inspector General (OIG), or another federal law enforcement agency, it is critical to engage legal counsel today.

Here are five reasons why healthcare providers in San Francisco and nationwide trust Oberheiden, P.C.:

  • Thousands of Federal Cases Handled – These cases utilized our skills as defense attorneys, along with several of our attorneys’ experience as federal healthcare fraud prosecutors with the DOJ.
  • Proven Pretrial Results – We have resolved the vast majority of our clients’ cases prior to trial, often without charges filed.
  • Aggressive and Strategic Representation – When we intervene in the government’s investigation, we apply pressure until we have achieved our desired result. We constantly look for the leverage and evidence we need to protect our clients.
  • Unwavering Commitment to Favorable Outcomes – We want the best for our clients, no matter what. We are passionate about what we do, and we are committed to our clients’ best interests.
  • Meticulous Trial Preparation – If it takes going to court to protect you, rest assured our San Franciso team will be thoroughly prepared. We are skilled litigators, and we have access to top medical experts around the country.

Frequently Asked Questions

What is a whistleblower claim?


The term whistleblower refers to a person who brings evidence of healthcare fraud to federal authorities. This is usually in hopes of securing a financial reward for themselves. Anyone with knowledge of potential healthcare fraud can bring a case on behalf of the government. When a whistleblower, also called a relator, provides information to the government, it must follow up on the allegations. If it finds the allegations are supported by evidence, the government may decide to intervene in the case. However, even if they do not intervene, the whistleblower can pursue the case at their own expense. If you suspect a whistleblower brought claims of healthcare fraud against you or your practice, contact an experienced San Francisco federal healthcare fraud defense attorney promptly.

Do I need to worry about a whistleblower who came forward with allegations of healthcare fraud?


It’s easy to ignore a whistleblower’s allegations because they receive a portion of any amount recovered in the case. It is important, however, to take these allegations seriously. They can—and often do—result in significant liability. If the whistleblower presents enough evidence to the federal government, it may intervene in the lawsuit. This means federal investigators and prosecutors take over the case. Even if the government does not intervene, the whistleblower may still decide to proceed alone. It is crucial to contact an experienced San Francisco, California federal healthcare fraud defense attorney as soon as you find out about a whistleblower’s allegations.

What is a Civil Investigative Demand?


A Civil Investigative Demand (CID) is a legal order seeking documents or other information related to an investigation. CIDs are a primary tool used by federal law enforcement and official agencies when examining claims of healthcare fraud. Federal agencies use CIDs to obtain information that may become the basis for future enforcement actions. If you receive a CID, you or your practice are not necessarily under investigation, however, that remains possible. It is important not only to respond to a CID, but to carefully consider your response. Contact a San Francisco federal healthcare fraud defense attorney to discuss your options before you respond.

Speak with a San Francisco Federal Healthcare Defense Lawyer at Oberheiden, P.C.

If you need to speak with a member of our federal healthcare fraud defense team, please call 888-680-1745 or contact us online. You can reach us 24/7. If a San Francisco federal healthcare fraud defense attorney is not available immediately, a member of our team will be in touch as soon as possible.

Additional Pages for San Francisco, 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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