Southern California Healthcare Attorneys

Proven Southern California Healthcare Attorneys

If you or your medical practice are among the many targets of a federal healthcare fraud investigation in Southern California, you need our experienced Southern California healthcare attorneys at Oberheiden, P.C.

The federal government is continuing a nationwide crackdown on healthcare fraud and other healthcare related crimes such as drug diversion. While new cases arise all over the country, Southern California has been one of the primary areas of focus for several major federal agencies. This includes the Drug Enforcement Administration (DEA) and the Department of Health and Human Services’ Office of Inspector General (DHHS – OIG).

Oberheiden, P.C., is a federal defense law firm. Contact a Southern California healthcare attorney who represents healthcare professionals, corporate officers, owners, and businesses in both civil and criminal investigations in Southern California.

Click image
to see larger version.

Our attorneys have more than 100 years of combined legal experience, much of it in federal healthcare fraud. Several of the attorneys in our office spent years as senior federal prosecutors. Plus, our Southern California healthcare attorneys have extensive experience in negotiating with federal agencies. We use that insight to help our clients, including management companies, make wise decisions. We always seek to avoid negative outcomes of a federal healthcare fraud investigation.

Don’t misjudge the seriousness of a federal investigation, the danger of interacting with federal agents, or the severity of a formal allegation, let alone health care law conviction. Hire an experienced team of defense veterans to protect you. Contact Oberheiden, P.C. law offices, to speak with a healthcare fraud defense attorney for Southern CA today.

What Is Healthcare Fraud?

Click image
to see larger version.

The United States criminal code has a surprising number of statutes aimed directly at the healthcare industry. These statutes put otherwise respected white-collar providers, such as medical groups, healthcare businesses, nurses, and physicians, in prison for years for non-violent crimes. Note the term “healthcare fraud” is something of a catch-all phrase. It may refer to any number of federal offenses or specific sections of the U.S. code. Accordingly, there are many ways to commit “healthcare fraud.”

When we enter a case, one of our first priorities is to determine two key pieces of information:

• Is the nature of the investigation civil or criminal?
• What specific agencies and/or task forces are involved?

Click image
to see larger version.

Those two items tell us a lot about what’s happening, what’s at stake, and how we should respond for our clients. Different agencies have different priorities when it comes to healthcare fraud enforcement. The DEA, DOJ, and the DHSS – OIG are among the primary investigators of healthcare fraud in Southern CA.

Some of the healthcare fraud allegations our California healthcare fraud defense attorneys have defended against at Oberheiden, P.C. include:

• Billing fraud (Medicare, Medicaid, Tricare, etc.)
• Department of Labor (DOL) fraud
• Anti-Kickback Statute violations
• Stark Law violations (physician self-referral)
• Controlled Substances Act / DEA registration violations (including prescription drug fraud)
• Providing / Billing for medically unnecessary services
• Billing for services not actually rendered to patients
• Falsifying patient records, prescriptions, physician certifications, or election statements

The Most Commonly Invoked Healthcare Fraud Laws

Below are some of the most common statutes, laws, regulations, and directives that result in the criminal prosecution of a healthcare provider or healthcare business in Southern CA.

1. The False Claims Act

The False Claims Act (FCA) is one of the most well-known healthcare fraud statutes. It prohibits the submission of “false or fraudulent” claims for payment to any federal benefits program. In most cases, the FCA is invoked in billing problems with Medicaid, Medicare, or Tricare. The law applies to healthcare entities who submits payment claims to these or other benefits programs. This includes:

• Physician’s groups,
• Hospitals,
• Medical supply companies,
• Ambulance operators,
• Mobile health companies, and
• Other businesses.

FCA penalties are applied per claim, so the toll of each fine and payment can quickly add up to an incredible sum. Additional results of FCA violation can include exclusion from federal benefits programs and/or prison sentences.

2. The Anti-Kickback Statute

When is a mutual marketing arrangement a crime? More often than you might think, thanks to the Anti-Kickback Statute (AKS). This statute makes it a crime to offer, solicit, pay for, or receive a referral fee, or any other form of “remuneration”, for referring a Medicare, Medicaid, Tricare, or DOL beneficiary. AKS violations may result in civil and/or criminal penalties, depending on the situation.

3. The Stark Law

Under the federal Stark Law, it is illegal for physicians to engage in so-called “self-referrals.” Many providers understand this basic concept. To be accused of violating the Stark Law when you had no idea you were “self-referring,” can be a surprise. For example, a doctor may stand accused of breaking the Stark Law for unwittingly referring a patient to a business with which the doctor has a distant financial relationship. Our federal defense attorneys are available to assist physicians or entities accused of Stark Law violations in Southern CA.

4. The Controlled Substances Act (CSA)

The Controlled Substances Act is a complex statute that creates a regulatory system while providing various criminal penalties. Many of the penalties are excessively harsh. The CSA gives the Drug Enforcement Administration much of its authority. Remember, the DEA isn’t just a regulatory organization, it’s a law enforcement agency. Common allegations made under the CSA include:

• Prescribing medications unnecessarily,
• Providing addictive drugs to patients with a history of abuse,
• Misappropriating prescription substances,
• “Selling” prescriptions,
• Pharmaceutical fraud, and
• Other unlawful practices.

5. The Federal Healthcare Fraud Statute

Referred to generally as “the healthcare fraud statute,” 18 U.S.C. 1347 makes it a crime to:

Congress designed the healthcare fraud statute to give prosecutors and investigators wide breadth and authority. It’s a useful tool for federal prosecutors in Southern CA who have been directed to increase their efforts against healthcare providers.

6. Other Fraud Statutes

Click image
to see larger version.

A healthcare fraud indictment often lists other, non-industry-specific charges. Wire fraud, mail fraud, bank fraud, and money laundering are common examples. Prosecutors are likely to build healthcare conspiracy cases as well. An example being, “conspiracy to commit healthcare fraud”.

7. Program Billing Regulations

Agencies like the CMS are authorized to propagate their own billing regulations that carry the force of law. Most fraud cases require proof of intent, but when it comes to federal program billing regulations, even unintentional violations can lead to criminal penalties. Civil recoupment actions are also possible and often add up to millions of dollars. These can come about as a result of a routine audit or investigation. For this reason, Southern CA healthcare providers must have a proactive compliance program to lessen the risk of prosecution.

8. DOJ Mandates

The DOJ frequently issues press releases and/or directives. These directives tell DOJ operatives how to prioritize their efforts. The DOJ mandated that healthcare fraud and opioid fraud and abuse be made national priorities. This is reflected in the launch of the Prescription Interdiction & Litigation (PIL) Task Force and the Opioid Fraud and Abuse Detection Unit. These efforts, combined with the existing Medicaid Fraud Strike Force office in Los Angeles, are responsible for many of the healthcare arrests in Southern CA.

5 Reasons to Trust Oberheiden, P.C., as a Federal Healthcare Fraud Defense Firm for Southern CA

Here are five reasons why healthcare providers and other Medicare, Medicaid, and Tricare participants should choose Oberheiden, P.C. as their Southern California federal healthcare fraud defense general counsel:

• Our Extensive Experience in Healthcare Fraud Investigations – We have handled thousands of federal healthcare fraud audits, investigations, and prosecutions on behalf of healthcare providers in Southern CA and nationwide.

• Our Record of Avoiding Charges – In the majority of our cases, our Southern California healthcare lawyers have reached a resolution in which the client did not have to face criminal charges.

• Our Focus on Federal Healthcare Fraud Defense – Much of our defense work over the years has been in the highly specific area of federal healthcare fraud defense. We have represented the following in disciplinary hearings:

  • Physicians,
  • Pharmacists,
  • Clinics,
  • Labs,
  • Hospitals,
  • Hospices, and
  • Virtually all other types of healthcare providers.
• Our Experience on Both Sides – Oberheiden, P.C. is comprised of both long-established federal defense attorneys and deeply experienced former federal prosecutors. We believe this “dual perspective” is of tremendous benefit to our clients.
• Our Aggressive Defense Strategies – Our Southern CA healthcare fraud defense attorneys take an aggressive approach to representing our clients. Our law firm has been designed so that we can quickly and cost-effectively develop tailored defense strategies for our clients, even on an emergency basis as needed.

Don’t make the mistake of facing the federal criminal justice system on your own. Choosing the right law firm could become the most important decision you will ever make.

FAQs About Healthcare Fraud in Southern California

Discuss Your Federal Healthcare Fraud Investigation in Confidence

If your Southern CA healthcare practice or company is being targeted in a federal healthcare fraud investigation, we strongly encourage you to contact us for a confidential case assessment. To speak with our Southern CA healthcare fraud defense lawyer for free, call 888-680-1745 or inquire online, right away.

Additional Pages for Southern California

• Southern California federal criminal defense
• Southern California criminal trial / litigation