Tallahassee Healthcare Attorneys
Tallahassee Healthcare Fraud Defense Team Lead
Former Deputy Chief, Appellate Division
1111 East Tennessee Street
Tallahassee, FL 32308
888-680-1745
Federal agents pursue healthcare providers in Tallahassee, Florida in a series of high-stakes criminal investigations. If your business or medical practice is being investigated, you need the experienced health care attorneys at Oberheiden, P.C. on your side.
The term “healthcare fraud” has become a household phrase, thanks in large part to sensational headlines about major “busts” of healthcare companies and white-collar professionals in the medical industry.
The aggressive Agency for Health Care Administration, Department of Justice (DOJ), and Department of Health and Human Services (DHHS) are cracking down on the healthcare industry.
Each week brings stories of new arrests. Many of those have come out of Tallahassee and Florida’s other major metropolitan areas.
Agents from the DEA (Drug Enforcement Administration) and the OIG (Office of Inspector General) are active in Tallahassee. Anyone submitting claims for payment to a federal health benefits program in Florida’s capital should be vigilant.
The attorneys at Oberheiden, P.C. are backed by their notable legal experience. Several of our Tallahassee healthcare attorneys have worked as federal prosecutors at the DOJ or other federal prosecutors’ offices. They have since moved to private legal defense.
In the majority of cases, our Tallahassee healthcare attorneys have been able to avoid having criminal charges filed against our clients. While we cannot promise specific outcomes in advance, we will fight to protect your medical license and DEA registration. Our goal is to keep you in practice, out of prison, and avoid exorbitant fines.
What Is Healthcare Fraud?
Healthcare fraud is broadly defined. This is based in part on the large number of federal statutes aimed at the healthcare industry.
There are many kinds of fraud under the healthcare law. Some common examples 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
We work to determine the type of fraud the investigation purports. Then, we’ll need to know which agencies are involved. We’ll find out how you came to be suspected of fraud. And finally, whether your investigation is considered criminal or civil in nature.
As soon as our Tallahassee health care lawyers get involved in a case, we begin working toward answers to these questions. We are often able to gain a lot of insight by contacting the agencies directly. The questions we ask you matter, as well. There may be seemingly minor details that could have a tremendous impact on your case. Our attorneys have the experience it takes to identify them.
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)
The Most Commonly Invoked Healthcare Fraud Laws
Below, we review some of the most common statutes, laws, regulations, and directives that result in criminal prosecution of health care providers in Tallahassee, FL.
1. The False Claims Act
The False Claims Act (FCA) is a major piece of federal legislation aimed directly at the healthcare industry. Under the FCA, it’s a crime to make “false or fraudulent” claims for payment to any federal health benefits program. The penalties for violating the FCA apply each time you submit a false or fraudulent claim. Because the government tends to prosecute these claims after a long pattern of billing problems, the fines can add up to a staggering sum. Additional penalties include program exclusion and/or a federal prison sentence.
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) is another major federal healthcare criminal statute. Under the AKS, it’s a crime to offer, pay, solicit, or receive any kind of remuneration, incentive, or reward for referring patients for healthcare services. It applies when the patient is a federal beneficiary, such as Medicare or Medicaid. The AKS provides for both civil and criminal penalties.
3. The Stark Law
The Stark Law is more narrow in scope than the statutes we’ve discussed so far. It applies to “physician self-referrals,” which are illegal under the Stark Law and can result in significant civil penalties.
4. The Federal Healthcare Fraud Statute
Many federal healthcare fraud indictments include at least one count of violating 18 U.S.C. 1347, better known as the “healthcare fraud statute.” This statute, which is broadly written and applied, reads (in part) as follows:
(a) “Whoever knowingly and willfully executes, or attempts to execute, a scheme or artifice –
(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, in connection with the delivery of or payment for healthcare benefits, items, or services, shall be fined under this title or imprisoned not more than 10 years, or both…”
5. The Controlled Substances Act (CSA)
The Controlled Substances Act is well known as the primary law governing drugs in this country. It applies to prohibited drugs, and medicinal substances that require a doctor’s prescription. The CSA is frequently used to investigate and prosecute healthcare providers who are suspected of:
- Writing unnecessary prescriptions,
- Selling prescriptions or selling medications,
- Committing pharmaceutical fraud,
- Giving drugs to patients with a history of substance abuse,
- Diverting painkillers, or
- Other unlawful practices.
Most “pill mill” cases in Tallahassee pertain to the Controlled Substances Act.
6. Other Fraud Statutes
In addition to the criminal statutes described above, healthcare providers in Tallahassee may face allegations of other related charges. These include:
- Wire fraud
- Mail fraud
- Forgery
- Making false statements
- Federal conspiracy
- Wrongful use of health information
7. Program Billing Regulations
Aside from the above statutes, healthcare benefits agencies such as the CMS may establish their own rules and regulations. Violating these program billing regulations can have extremely serious outcomes. It applies even if there is no evidence of intent. Most other healthcare fraud statutes do require proof of intent. Care providers in Tallahassee can lessen their risk of prosecution by maintaining a proactive compliance program.
8. DOJ Mandates
From time to time, the U.S. Department of Justice issues new departmental mandates. These are often attempts to curry favor with the public. They are used to assure voters that federal agents remain “tough on crime.” Political polls often show that the public is very concerned about taxpayer fraud, waste, and abuse. Accordingly, DOJ mandates often target those kinds of crimes. Arresting successful white-collar professionals attracts media attention, so it’s not uncommon for DOJ mandates to target healthcare. Indeed, the DOJ created two task forces for this purpose; the Opioid Fraud and Abuse Detection Unit, and the Prescription Interdiction & Litigation Task Force (PIL).
5 Reasons to Choose Oberheiden, P.C., and Our Tallahassee Federal Healthcare Fraud Defense Lawyers
Here are five reasons why healthcare professionals and businesses in the Tallahassee area should trust Oberheiden, P.C. as their federal healthcare fraud defense attorneys:
- Our Extensive Experience in Healthcare Fraud Investigations – There is no substitute for experience. A Tallahassee healthcare lawyer in our team has represented providers and business entities in thousands of federal healthcare fraud audits, investigations, and criminal cases.
- Our Record of Avoiding Charges – We can never guarantee a particular outcome in advance. But, we are proud to have avoided criminal charges for most of our healthcare clients. Make no mistake, avoiding charges is the most effective way to resolve a criminal investigation. That is the goal we fight toward whenever possible.
- Our Focus on Federal Healthcare Fraud Defense – While we handle many types of white-collar defense, healthcare fraud defense is a primary focus. Our healthcare fraud defense lawyers are available to represent:
- Physicians,
- Pharmacists,
- Clinics,
- Hospitals,
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Home health agencies and hospices,
- Medical laboratories,
- Mobile labs,
- Ambulance providers,
- Diagnostic companies, and
- Virtually every other category of healthcare provider.
- Our Experience on Both Sides – Several of the Tallahassee healthcare lawyers at Oberheiden, P.C. are former federal prosecutors. They spent years working in the DOJ or other prosecutorial positions.
- Our Aggressive Defense Strategies – When the stakes are high, you need attorneys who will fight for you as if their own freedom depended on it. We believe in taking an aggressive approach on legal matters. Every time.
Don’t make the mistake of facing the federal criminal justice system on your own. Choosing the right law firm can make all the difference in the outcome of your criminal investigation or federal charges.
Discuss Your Federal Healthcare Fraud Investigation in Confidence
If your healthcare practice or company is a target in a federal healthcare fraud investigation, our proven Tallahassee healthcare fraud lawyer strongly encourages 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.
