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Santa Ana Healthcare Fraud Defense Lawyer

What if your Santa Ana healthcare business or medical practice is targeted in a federal fraud investigation? Your livelihood, your ability to serve your patients, and your freedom could be at risk. Our Santa Ana healthcare fraud defense lawyers bring their combined legal experience to defend providers, business owners, and other clients in high-stakes federal healthcare fraud investigations.

The U.S. Department of Justice (DOJ). The Drug Enforcement Administration (DEA). The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). You knew these agencies existed, but you never expected to deal with them in the course of your business or practice.

Healthcare providers and business owners in Santa Ana, California risk targeting by federal authorities. The DOJ publicly announced that it’s aggressively investigating healthcare providers suspected of defrauding Medicare, Medicaid, and Tricare. Those suspected of improperly prescribing or dispensing opioid medications are also under scrutiny. Other forms of healthcare fraud can lead to intense federal attention as well. Providers in DOJ, DEA, OIG, and other agency investigations face the potential for fines, treble damages, program exclusion, prison time, and other penalties.

At Oberheiden, P.C., we focus on representing:

  • Physicians,
  • Pharmacists,
  • Physician groups,
  • Durable medical equipment (DME) companies,
  • Labs,
  • Hospitals,
  • Clinics,
  • Executives and board members, and other entities and individuals in high-stakes federal matters.
  • Our team of more than 15 defense attorneys includes several former federal healthcare prosecutors. Together with our lawyers, we have notable experience on both sides of federal healthcare cases. If your practice or business in Santa Ana is under investigation, we can help. They key is to contact us right away. To speak with our Santa Ana healthcare fraud defense attorneys in a free and confidential case assessment, call 888-680-1745 now.

    What Is Healthcare Fraud?

    What exactly does it mean to face allegations of healthcare fraud from the federal government? While healthcare fraud takes many forms, most cases involve an allegation of improperly billing Medicare, Medicaid, Tricare, or the Department of Labor (DOL). Any form of “false or fraudulent” billing can lead to charges. Making improper use of program reimbursed funds for things like marketing fees and referrals can also trigger suspicion.

    To find out why you are under investigation, it’s critical to promptly intervene in the government’s case. At this point, you are already at a disadvantage. You need to engage a legal team to take swift and decisive action to help level the playing field. With our extensive experience on both sides of fraud investigations, we take action right away to:

    • Determine which agency (or agencies) are handling your investigation;
    • Determine the specific factual allegations against you;
    • Determine whether the investigation is civil or criminal in nature;
    • Determine how close federal prosecutors are to filing charges; and
    • Determine the most appropriate strategy for securing a favorable outcome as quickly as possible.

    Even if you’re sure your billing practices are compliant, avoid making any assumptions or decisions. You first need to have a clear picture of the government’s case against you. Our Santa Ana healthcare fraud defense attorneys can get you details quickly. We can help you execute a defense strategy allowing you to get back to business as usual with minimal delay.

    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) is one of the federal government’s primary weapons in the fight against healthcare program fraud. Inquiries conducted by the DOJ, DEA, OIG, and other agencies routinely involve allegations of False Claims Act violations. This includes submitting “false or fraudulent” claims for Medicare, Medicaid, Tricare, or DOL reimbursement. Civil monetary penalties under the FCA apply on a per-claim basis. That means each individual billing is a separate “claim”. Providers charged civilly can face recoupments, treble damages, litigation costs, program exclusion and other penalties. The FCA also includes criminal provisions for prosecution of intentional violations. Under criminal charges, providers face the potential for substantial fines and years or decades of imprisonment.

    2. The Anti-Kickback Statute

    The Anti-Kickback Statute (AKS) includes civil and criminal penal provisions similar to the False Claims Act. The Act prohibits the offering, soliciting, payment, or receipt of any bribe, referral fee, kickback, or other forms of “remuneration” in connection with program reimbursed healthcare services. This can include marketing, management, or research fees, and various other forms of compensation. The AKS’s prohibitions are extremely broad. In many cases, a provider’s best defense is to demonstrate that one of the statute’s “safe harbor” provisions applies to the transaction in question.

    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. This is more commonly known as the prohibition on “physician self-referrals.” The Stark Law includes provisions for civil penalties only. However, those targeted in Stark Law investigations can be at risk for hundreds of thousands or millions of dollars in aggregate financial liability.

    4. The Controlled Substances Act

    The Controlled Substances Act sets DEA registration requirements for providers who prescribe, administer, and dispense prescription drugs. It’s also the primary statute used against healthcare providers suspected of opioid diversion and other forms of pharmaceutical fraud. Prosecutions under the Controlled Substances Act can result in serious criminal charges. The potential for substantial fines and long-term imprisonment are real risks.

    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.” Penalties under 18 U.S.C. 1347 include statutory fines and maximum prison sentences of 10 years, 20 years, or life behind bars depending upon the specific factual circumstances involved (i.e., whether a violation resulted in serious bodily injury or death to a patient).

    6. Program Billing Regulations

    Violations of Medicare, Medicaid, Tricare and DOL billing regulations can lead to charges under the False Claims Act, the healthcare fraud statute, and the other statutes noted above. This applies not only for intentional violations that can trigger criminal prosecution, but for unintentional violations as well. It’s critical that providers show ongoing and active efforts to strictly adhere to a current billing compliance program.

    7. Other Federal Criminal Statutes

    In criminal healthcare fraud cases, physicians, pharmacists, executives, board members, and others can face charges under a variety of other federal statutes. 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 Santa Ana, CA

    Santa Ana Healthcare Fraud Defense LawyerOur attorneys provide aggressive legal counsel for federal healthcare fraud cases in Santa Ana, CA. When you choose our team of highly-experienced healthcare fraud defense lawyers to represent you:

    • You Will Have Notable Federal Experience on Your Side. Our attorneys have handled thousands of investigations and hundreds of trials as defense counsel and former federal prosecutors.
    • You Will Have Access to Your Attorneys 24/7. We are here for you when you need us. When we represent you, we make ourselves available to you 24/7.
    • We Will Execute a HighlyCustomized Case Strategy. We tailor our defense to the unique facts of each case. We focus defense strategies on quickly securing a favorable outcome based on your situation.
    • We Will Pursue Every Available Opportunity for Pretrial Resolution. If at all possible, we seek to resolve your case without going to trial. Ideally this occurs before civil or criminal charges are filed.
    • We Will Be by Your Side until Your Case Is Over. If it takes going to trial to protect you, our attorneys will vigorously represent you in court. And if necessary, we will fight for a just outcome on appeal.

    Frequently Asked Questions

    Which providers are most commonly investigated for healthcare fraud?

     

    No healthcare provider, DME manufacturer, hospital or practice group is immune from healthcare fraud allegations. But, some are at greater risk than others. Federal law enforcement and regulatory authorities tend to target the following providers:

    • DNA testing facilities;
    • Drug rehabilitation facilities;
    • Healthcare marketing agencies;
    • Home healthcare agencies;
    • Hospice providers;
    • Hospitals;
    • Mobile healthcare clinics;
    • Outpatient surgical centers; and
    • Toxicologists and toxicology laboratories.

    As the subject of healthcare fraud allegations, it’s vital to consult a Santa Ana federal healthcare fraud defense attorney as soon as possible. It is important to discuss your options before charges are filed.

    Will the government pursue charges if I honestly didn’t know about a violation?

     

    It depends. Generally speaking, the government doesn’t need to prove that you intended to engage in healthcare fraud. Most healthcare fraud statutes are liability offenses. That means there is a knowledge element that does not require the intent to defraud. These cases proceed based on your knowledge of the submission itself. If there were errors in a claim you filed to Medicare, you can be liable if you knew or should have known about them. This is how many honest and well-intentioned providers fall into a healthcare fraud investigation. If under investigation for healthcare fraud, it’s critical to contact a Santa Ana, CA federal healthcare fraud defense attorney. You deserve to have the best chance at favorably resolving your case.

    What is a Civil Investigative Demand?

     

    A Civil Investigative Demand (CID) is a type of administrative subpoena used by federal agencies during an investigation. Typically, a federal agency issues a CID before it files formal charges. Anyone in receipt of a CID is compelled to respond, unless they can show that the CID was improperly issued. CIDs are often very broadly phrased, and it can be very burdensome to gather the covered documents. However, providers and practice groups in receipt of a CID can negotiate to potentially narrow its scope. This can make compliance much easier. It also decreases the risk of providing too much information to investigators. This could end up raising suspicion down the road. To learn more about the best way to respond to a CID, contact a federal healthcare fraud defense attorney.


    Contact a Santa Ana Healthcare Fraud Defense Attorney at Oberheiden, P.C.

    To discuss your federal healthcare fraud investigation in Santa Ana with our Santa Ana healthcare fraud defense lawyer, please call 888-680-1745 or contact us online. We will schedule your free initial case assessment as soon as possible.

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