Southern Florida Healthcare Attorneys
If you are being investigated for healthcare fraud in Southern Florida, you need the experienced federal defense team at Oberheiden, P.C.
Southern Florida Healthcare Fraud Defense Team Lead
Former Deputy Chief, Appellate Division
2250 Southwest 3rd Ave, 4th Floor
Miami, FL 33129
305-928-8505
The United States government continues its focus on issues of fraud, waste, abuse, and prescription misuse in healthcare. And, providers in Southern Florida are targets for healthcare law investigation. Miami is home to one of the largest populations of Medicaid / Medicare recipients. The federal government allocates additional resources to the Southern Florida area, including the Miami-based Medicare Fraud Strike Force office. Health care providers and companies in South Florida may be more likely to come under scrutiny as a result.
What you should know is that the early stages of an investigation are extremely important. Don’t make the mistake of thinking it’s premature to contact a Southern Florida healthcare attorney. The beginning stages are the best time to end the matter before it goes to a grand jury or result in a criminal indictment.
Oberheiden, P.C. is a federal healthcare fraud defense firm representing healthcare providers, corporate officers, owners, and businesses in both civil and criminal inquiries in south Florida. The attorneys in our firm offer more than 100 years of combined experience in legal matters. Several members of our team are former federal prosecutors. Our Southern FL healthcare fraud defense attorneys also have extensive experience negotiating with agencies like the Drug Enforcement Administration (DEA) and the Department of Health and Human Services Office of the Inspector General (DHSS – OIG). That experience helps us bring the majority of our clients’ cases to a close with zero criminal charges filed. Let us fight to protect you from the serious threat of criminal prosecution. Call us for a free consultation today.
What Is Healthcare Fraud?
Healthcare fraud can take many forms. Any act of misrepresentation to a healthcare program can constitute healthcare fraud. Prosecutors have their choice of many federal statutes that might apply in cases of healthcare fraud. Some statutes apply only when the alleged victim is a federal program (e.g., Medicare, Medicaid, Tricare, the Department of Labor, etc.), while others also apply to defrauding a private insurance company. The precise nature of the charges determines the potential penalties as well as the best strategy for defense. Some healthcare fraud allegations our Southern Florida healthcare 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;
When we enter a healthcare industry case, one of our first priorities is to get answers to two important questions:
- Is the investigation civil or criminal?
- What specific agencies and/or task forces are involved?
These two items tell us a lot about what’s happening, what’s at stake, and how our health law firm should respond to protect you. We then develop a tailored strategy grounded in our aggressive, tested and proven approach to defense.
The Most Commonly Invoked Healthcare Fraud Laws
Below, we review a few of the most common statutes, laws, Florida healthcare regulations, and directives that result in the criminal prosecution of healthcare professionals in South Florida.
1. The False Claims Act
The False Claims Act (FCA) bans the submission of “false or fraudulent” claims for payment to any federal benefits program. In most cases, the FCA is invoked in billing discrepancies with Medicaid, Medicare, or Tricare. Sadly, our Southern Florida healthcare lawyers have seen cases throughout the state where a healthcare practice makes simple clerical errors or good-faith mistakes of judgment. The mistakes are then taken by the government as evidence of criminal fraud. Penalties for False Claims Act cases can be steep, and fines are applied per claim. The toll of each fine and reimbursement can quickly add up to an effectively unpayable sum. Additional results of FCA violations can include exclusion from federal benefits programs and/or prison sentences.
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) makes it a crime to offer, solicit, pay for, or receive a referral fee, or any other form of “remuneration”, in exchange for referring a Medicare, Medicaid, Tricare, or DOL beneficiary. The statute’s prohibitions extend to a wider range of business arrangements than many people realize. We have helped many clients who were shocked to find themselves accused of violating the AKS. 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 “self-refer.” Here again, the statute covers a broader range of conduct than is apparent at first glance. We’ve helped many physicians who were only trying to get their patients the best available care. Then, later learn that the referral constituted an alleged violation of the Stark Law. A Southern FL healthcare fraud defense lawyer at Oberheiden, P.C. is available to assist physicians or businesses accused of Stark Law violations.
4. The Controlled Substances Act (CSA)
is a complex statute. It’s used to convict illicit drug dealers, to regulate prescription medications and those who prescribe them, and to target healthcare professionals for criminal prosecution. 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
- Other unlawful practices
5. The Federal Healthcare Fraud Statute
18 U.S.C. 1347 is a broad and far-reaching statute that is most widely referred to as simply “the healthcare fraud statute.” It makes it a crime to:
The broad language here gives prosecutors wide discretion. However, our attorneys have a record of avoiding or defeating such healthcare fraud allegations in the majority of cases.
6. Other Fraud Statutes
In addition to the criminal statutes described above, healthcare providers frequently face allegations of:
- Wire fraud,
- Mail fraud,
- Forgery,
- Making false statements,
- Federal conspiracy to commit healthcare fraud, and
- Other serious charges.
7. Program Billing Regulations
Federal healthcare benefits programs establish their own rules and regulations, the violation of which, even if unwitting, may lead to overwhelming penalties. Care providers in Southern FL can mitigate the risk of prosecution by maintaining a current compliance plan.
8. DOJ Mandates
The Florida Department of Justice mandates are public statements or internal instructions about what kinds of cases should be a priority. Currently, healthcare fraud and opioid diversion are among the Department’s top priorities. Case in point – the launch of both the Prescription Interdiction & Litigation (PIL) Task Force and the Opioid Fraud and Abuse Detection Unit.
5 Reasons to Trust Oberheiden, P.C. and Our Southern FL Federal Healthcare Fraud Defense Lawyers
Here are five reasons healthcare providers and other Medicare, Medicaid, and Tricare participants in Southern FL should choose Oberheiden, P.C., as their federal healthcare fraud defense lawyer:
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Our Extensive Experience in Healthcare Fraud Investigations – We have handled thousands of federal healthcare fraud audits, government investigations, and prosecutions on behalf of healthcare providers in Southern FL and nationwide.
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Our Record of Avoiding Charges – In the majority of our cases, our Southern Florida healthcare lawyers have reached a resolution where our client does not face criminal charges.
- Our Focus on Federal Healthcare Fraud Defense – We concentrate most of our defense work in the area of federal healthcare fraud defense. We have represented:
- Physicians,
- Pharmacists,
- Clinics,
- Laboratories,
- Hospitals,
- Hospices, and
- Virtually every other category of healthcare provider.
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Our Experience on Both Sides – Oberheiden, P.C., is composed of both long-established federal defense attorneys and widely experienced former federal prosecutors. We believe this dual perspective helps us properly assist clients and negotiate efficiently and effectively with federal prosecutors.
- Our Aggressive Defense Strategies – We take an aggressive approach to defending our clients, precisely because the stakes are so high. A Southern FL healthcare fraud defense attorney at Oberheiden, P.C. also offers an Emergency Defense Package for urgent legal crises.
Don’t make the mistake of facing the federal criminal justice system on your own. Choosing the right legal counsel could become the most important decision you will ever make.
Frequently Asked Questions
What is the Anti-Kickback Statute?
The Anti-Kickback Statute (AKS), codified in 42 U.S.C. §1320a–7b, is a federal law prohibiting certain referrals for patients receiving government benefits through federally funded programs. The AKS forbids the offering, paying, soliciting, or receiving anything of value in exchange for patient referrals. Cash referrals form the basis of most AKS violations. However, the statute covers the exchange of anything of value. This includes lavish vacations, meals, or even employment offers. The AKS is a criminal statute, and a conviction carries the potential of prison –– up to five years in state prison per offense –– along with other criminal sanctions. However, those in violation may also face civil penalty under the False Claims Act. If facing a violation under the Anti-Kickback Statute, it is imperative to protect yourself by contacting a dedicated Southern Florida healthcare attorney for proper legal protection as soon as possible.
What is at stake in a federal healthcare fraud lawsuit?
A violation of a federal healthcare fraud law can result in either civil or criminal liability or, in some cases, both. Some statutes provide for only civil liability, some for only criminal liability. Others provide for civil or criminal liability, depending on the situation. In a civil healthcare fraud case, punishments are typically significant fines and professional sanctions. An example of such sanctions is being barred from participating in federally funded programs. Criminal healthcare fraud cases can result in these outcomes, as well as the possibility of incarceration. If you recently learned you are the suspect of a healthcare fraud investigation, it’s important to contact an experienced federal criminal defense attorney as soon as possible. It’s critical to learn more about the allegations and what you can do to defend against them.
When should I reach out to a Southern Florida federal healthcare fraud defense attorney?
The sooner you contact a Southern Florida federal healthcare fraud defense attorney, the better. There are a few reasons why this is the case. When you first learn of federal healthcare charges it may not be clear if you are facing civil or criminal liability. An experienced attorney will know the questions to ask to determine exactly what the accusations are. From there, a skilled attorney will focus on removing the potential for criminal liability. Once criminal charges are off the table, you have more breathing room and can focus on defending against the civil charges. If you are under investigation for federal healthcare fraud, talk to a Southern Florida federal healthcare fraud defense attorney as soon as possible. The sooner you contact a lawyer, the more options they will have to favorably resolve the case.
Discuss Your Federal Healthcare Fraud Investigation in Confidence
If your Southern FL healthcare practice or company is being targeted in a federal healthcare fraud investigation, our Southern FL healthcare fraud defense attorneys strongly encourage you to contact us for a confidential case assessment. To speak with a member of our federal defense team for free, call 888-680-1745 or inquire online, right away.
