San Jose Healthcare Fraud Defense Lawyers

Healthcare fraud allegations cause many San Jose practitioners and business owners to suffer serious outcomes in federal investigations. If your practice or business is under investigation for healthcare fraud, it’s important to speak with our San Jose healthcare fraud defense lawyers right away.

Healthcare providers in San Jose and around the country are facing a host of allegations in federal investigations. These allegations have the potential to cause long-term damage, even if they don’t lead to federal charges. Reputations ruined and licenses revoked by state medical boards are examples of the damage possible. There are many more ways healthcare fraud allegations can cause devastating fallout, even without fines or prison time.

At Oberheiden, P.C., we provide skilled and aggressive legal counsel for federal healthcare fraud investigations in San Jose, California. Our practice represents healthcare providers and medical businesses in federal investigations. We have achieved favorable outcomes at all stages from investigation through appeal. In our experience, most allegations against legitimate healthcare providers are misguided. Are the allegations against you groundless? Have you been unfairly targeted for prosecution? We will do our utmost to defend you. We always strive towards a favorable outcome as quickly and discreetly as possible.

Your practice or business is under investigation for healthcare fraud. And, there are steps you should take to minimize your risk of federal prosecution. The San Jose healthcare fraud defense attorneys on our team can guide you through everything you should be doing. We encourage you to contact us promptly for a free and confidential consultation.

Understanding Healthcare Fraud Allegations

Under federal law, “healthcare fraud” is a general term to describe an array of civil and criminal allegations. While there is a federal healthcare fraud statute, 18 U.S.C. 1347, healthcare fraud can take a variety of other forms. And, it can be prosecuted under a variety of other statutes. We routinely represent healthcare providers and medical business owners who fight allegations such as:

• Medicare, Medicaid, and Tricare coding violations (“billing fraud”)
• Department of Labor (DOL) fraud
• Providing and billing for medically-unnecessary services
• Billing for services not actually rendered to patients (or “phantom billing”)
• Unlawful “kickbacks” or referral fees (Anti-Kickback Statute violations)
• Unlawful physician “self-referrals” (Stark Law violations)
• Prescription drug fraud (Controlled Substances Act violations)
• Falsifying patient records, prescriptions, physician certifications, and election statements

No matter the allegations against you and how accurate or false you believe they are, you must take them very seriously. Your investigation isn’t going away on its own. For a chance to avoid federal prosecution, possibly criminal charges and the risk of a long prison sentence, you must mount an effective defense.

When we represent healthcare providers and medical business owners in federal fraud investigations, we emphasize being proactive. If we can resolve your case at the investigative stage, you won’t face charges. Plus, you won’t suffer the uncertainty of taking your case to trial. In order to protect yourself, contact a San Jose healthcare fraud defense lawyer.

• Intervene in the investigation to determine the scope and nature (i.e., civil or criminal) of the allegations against you;
• Advise you and your personnel on how to deal (or not deal) with federal agents and other mistakes to avoid;
• Strategically assert affirmative defenses that challenge the underlying basis of the government’s investigation; and
• Challenge the government’s methods and assumptions in order to convince prosecutors that charges are not warranted.

Put our highly experienced team on your side

Dr. Nick Oberheiden

Founder

Attorney-at-Law

Lynette S. Byrd

Former DOJ Trial Attorney

Partner

Brian J. Kuester

Former U.S. Attorney

Hon. Kevin McCarthy

55th Speaker, U.S. House of Representatives (ret.)

Government Consultant

Mike Pompeo

Of Counsel

Former U.S. Secretary of State

John W. Sellers

Former Senior DOJ Trial Attorney

Linda Julin McNamara

Federal Appeals Attorney

Nicholas B. Johnson

Former Prosecutor

Roger Bach

Former Special Agent (DOJ)

Chris J. Quick

Former Special Agent (FBI & IRS-CI)

Michael S. Koslow

Former Supervisory Special Agent (DOD-OIG)

Ray Yuen

Former Supervisory Special Agent (FBI)

Experienced San Jose Healthcare Fraud Defense Attorneys for All Healthcare Fraud Matters

With our extensive experience on both sides of federal healthcare fraud investigations, we have handled cases involving all types of allegations. This includes allegations under:

1. The False Claims Act

The False Claims Act (FCA) imposes civil and criminal penalties for submitting “false or fraudulent” claims for federal healthcare program payment. This includes all forms of billing violations such as:

• Upcoding,
• Unbundling,
• Phantom billing, and
• Billing for medically-unnecessary services and supplies.

Civil penalties under the FCA include:

• Recoupments,
• Civil assessments,
• Fines, and
• Program exclusion.

Criminal violations (those committed with “intent”) carry fines and prison time.

2. The Anti-Kickback Statute

The Anti-Kickback Statute (AKS) (AKS) prohibits the offer, payment, solicitation, and receipt of referral fees and all other forms of compensation in connection with referrals for federally reimbursed healthcare services. Like the False Claims Act, the AKS has provisions for civil and criminal penalties, with intent being the discernible factor between civil and criminal penalties.

In federal healthcare fraud investigations under the Anti-Kickback Statute, a key defense strategy is often to establish protection under one of the statute’s “safe harbor” provisions. The AKS includes safe harbors for:

• Bona fide employment relationships
• Discounts
• Group purchasing organizations
• Investment Interests
• Management contracts
• Office and equipment rentals
• Personal service arrangements
• Practitioner recruitment
• Price reductions
• Referral services
• Sale of healthcare practice
• Waivers of copayments, coinsurance, and deductibles
• Warranties

3. The Stark Law

The Stark Law prohibits so-called “physician self-referrals.” It is strictly a civil statute. Even in civil cases, physicians and their “related entities” can face substantial financial penalties and loss of Medicare and Medicaid eligibility. Similar to the Anti-Kickback Statute, the Stark Law contains broad prohibitions tempered by a list of statutory and regulatory exceptions. If an exception applies, our San Jose healthcare fraud defense attorney can use it to protect you against prosecution.

4. The Controlled Substances Act

The Controlled Substances Act is one of the primary federal statutes used to prosecute healthcare providers who commit pharmaceutical fraud. This includes billing for medically unnecessary items, overbilling, forging, falsifying and, improperly filling prescriptions, and providing opioid medications to drug-dependent individuals. The Controlled Substances Act includes severe criminal penalties. Healthcare providers and medical business executives targeted under the Controlled Substances Act must be prepared to staunchly defend themselves.

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.” Violations of 18 U.S.C. 1347 carry fines and up to 10 years in prison for most cases. Longer terms of 20 years to life can result for violations resulting in serious bodily harm or death.

6. Program Billing Regulations

Healthcare providers who violate Medicare, Medicaid, Tricare, and DOL billing regulations can face prosecution under the False Claims Act, 18 U.S.C. 1347, and various other federal laws. Under the civil enforcement provisions of many of these laws, providers can be penalized if they “should have known” an improper claim or claims was submitted.

7. Other Federal Criminal Laws

In criminal healthcare fraud cases, providers, company owners, and executives can face charges for multiple offenses, not only healthcare-related ones. This includes charges for:

• Attempt,
• Conspiracy,
• Bank fraud,
• Mail and wire fraud,
• Money laundering,
• Tax evasion, and
• Assorted other white-collar crimes.

Trusted San Jose Healthcare Fraud Defense Lawyers

With ample experience in federal healthcare fraud situations, Oberheiden, P.C.’s healthcare fraud defense attorneys are trusted advocates for licensed healthcare providers, business owners, company executives, board members, and other clients in civil and criminal matters. Here is what you can expect when you engage our healthcare fraud defense team to represent you in San Jose, CA:

• Proactive and aggressive legal representation focused on securing a prompt and favorable resolution.
• Defense strategies backed by experience in more than 2,000 investigations.
• Unwavering commitment to your best interests and a client-first approach in all aspects of your representation.
• Direct access to your team of senior healthcare fraud defense attorneys (we do not employ any junior associates or paralegals).
• Personalized case strategies that utilize the facts and circumstances of your investigation to protect you against long-term consequences.

Frequently Asked Questions

Schedule a Free Initial Consultation at Oberheiden, P.C.

Is your healthcare business or medical practice under investigation in San Jose, CA? If so, we strongly encourage you to schedule a free initial consultation with our healthcare fraud defense team. You can reach us 24/7. If necessary, our San Jose healthcare fraud defense attorneys can get to work on your case immediately. To learn more about how we defend healthcare providers in federal fraud investigations, call 888-680-1745 or get in touch online now.

Additional Pages for San Jose, California

• San Jose federal criminal defense
• San Jose SEC defense
• San Jose white collar crime