Virginia Healthcare Fraud Defense Attorneys - Oberheiden, P.C.
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Virginia Healthcare Fraud

Proven Virginia Healthcare Fraud Defense Attorneys

Dr. Nick Oberheiden
Attorney Nick Oberheiden
Virginia Healthcare Defense Team Lead envelope icon Contact Nick
Virginia address – by appointment only:
2800 Eisenhower Avenue
Alexandria, VA 22314
703-952-0247

Federal authorities target healthcare providers throughout Virginia in high-stakes fraud investigations. If your business or practice is under federal scrutiny, call the experienced federal defense team at Oberheiden, P.C.

Healthcare providers in Virginia are in the federal government’s cross-hairs. From drug diversion to payment of unlawful referral fees, agencies like the Drug Enforcement Administration (DEA) and the Department of Health and Human Services (DHHS) target providers for a range of federal healthcare law violations.

Oberheiden, P.C., is a federal healthcare fraud defense law firm representing providers and other industry members in civil and criminal probes in Virginia. Our Virginia healthcare fraud defense attorneys are highly experienced. Many have prior experience as senior federal prosecutors. This background helps clients make smart decisions in federal healthcare fraud investigations.

Are you being targeted for submitting “false or fraudulent” claims to Medicare, Medicaid, or Tricare? Are you being accused of contributing to the nation’s opioid epidemic? Are you, like many healthcare providers, at a loss as to why you are facing government scrutiny? We can use our extensive experience to help. We can deal with the government on your behalf letting you get back to managing your business or practice.

What Is Healthcare Fraud?

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What does it mean to be under federal investigation for healthcare fraud? Sadly, this question doesn’t have an easy answer. Agency complexity explains the difficulty in responding to an inquiry from the DEA, the DHHS Office of Inspector General (OIG), and the DOJ. The same is true of any other federal agencies or task forces involved in healthcare fraud enforcement.

“Healthcare fraud” is a broad range of violations under a list of federal statutes. Included are both civil and criminal violations, such as medical fraud, drug fraud, and health insurance fraud. In addition, different agencies have different priorities when it comes to healthcare fraud investigations. There are two pieces of information critical to the initial stages of building an effective defense:

  • The nature of the investigation (i.e., is it civil or criminal?); and
  • The specific agency or agencies and/or task force or forces involved.

From this information, it’s possible to discern the issues or allegations triggering the investigation. A comprehensive defense strategy, custom-tailored to the specific facts and circumstances involved, follows.

At Oberheiden, P.C., Virginia healthcare fraud defense attorneys represent healthcare providers in federal investigations involving all healthcare fraud allegations. We represent practitioners, providers, and businesses accused of:

  • Medicare, Medicaid, and Tricare coding violations (“billing fraud”)
  • Department of Labor (DOL) fraud
  • Anti-Kickback Statute violations
  • Stark Law violations
  • Controlled Substances Act and DEA registration violations (including prescription drug fraud)
  • Providing and billing for medically-unnecessary services
  • Billing for medical services not actually rendered to patients
  • Falsifying patient records, prescriptions, physician certifications, and election statements

No matter the specific accusation, it’s critical to engage experienced legal counsel right away. Our federal healthcare fraud defense team is available 24/7. You can speak with one of our Virginia healthcare fraud defense lawyers about your situation in person or over the phone.

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) bans submission of any “false or fraudulent” claim for payment by the federal government. The FCA applies to healthcare providers and others billing any healthcare benefit program. The FCA includes provisions for civil and criminal penalties. Since these penalties apply on a “per-claim” basis, those accused of violating the FCA can face huge financial penalties. Plus, possible program exclusion and prison time.

2. The Anti-Kickback Statute

The Anti-Kickback Statute (AKS) prohibits the offer, payment, solicitation, and receipt of referral fees and all other forms of “remuneration” connected to referrals for federally funded healthcare recipients. Like the False Claims Act, the Anti-Kickback Statute allows both civil and criminal prosecution of healthcare providers. Providers charged with AKS violations can face life-altering and practice-threatening penalties.

3. The Stark Law

The Stark Law prohibits so-called “physician self-referrals.” While the Stark Law is more limited in scope than the FCA and the AKS, physicians and related entities targeted in Stark Law inquiries can still face sizable civil penalties.

4. The Controlled Substances Act

The Controlled Substances Act is one of the primary federal statutes used to prosecute providers suspected of engaging in pharmaceutical fraud. This includes:

  • Providing prescriptions for unnecessary medications,
  • Providing drugs to dependent patients,
  • Diverting prescription medications,
  • Selling prescriptions, and
  • Various other unlawful practices.

The Controlled Substances Act is a piece of legislation that does everything from authorizing the DEA to establishing the federal “schedules” of controlled substances. It also includes criminal provisions with major penalties.

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.” Similar to the False Claims Act, the healthcare fraud statute is extremely broad and provides federal prosecutors with many ways to target healthcare providers. It presents one of the greatest risks in many healthcare fraud investigations.

6. Program Billing Regulations

In addition to federal statutes listed above, healthcare providers that participate in Medicare, Medicaid, Tricare, DOL, and other healthcare benefit programs are also subject to these programs’ billing regulations. Intentional and unintentional violations such as false billing or wrongful billing can trigger recoupments and other penalties during audits and reviews. If you’re wondering, ‘Can you sue for wrongful billing?’, it’s important to note that wrongful billing allegations can lead to investigations and potential healthcare fraud charges. With these regulations constantly changing, providers must maintain stringent compliance programs in order to mitigate their risk of prosecution.

7. DOJ Mandates

The Department of Justice routinely issues notices outlining new law enforcement priorities and task forces. Its directions guide enforcement proceedings targeting healthcare providers in specific areas of the industry and for certain types of violations. The DOJ has intensified its focus on opioid fraud and abuse resulting in the Opioid Fraud and Abuse Detection Unit and the Prescription Interdiction & Litigation (PIL) Task Force.

These are in addition to the numerous federal laws and other sources of authority that can come into play in healthcare fraud cases. It’s common for DOJ prosecutors to seek evidence to charge providers and company executives with:

  • Mail fraud,
  • Wire fraud,
  • Tax fraud,
  • Money laundering,
  • Conspiracy to commit fraud, and
  • Various other federal offenses.

5 Reasons to Choose Oberheiden, P.C., and our Virginia Federal Healthcare Fraud Defense Lawyers

You have been contacted by federal authorities, what now? With the extreme complexities involved in federal healthcare fraud cases, your next step should be to engage a proven federal defense law firm right away. Here are five reasons why healthcare providers and other Medicare, Medicaid, and Tricare participants in Virginia should hire Oberheiden, P.C.:

  • Our Team of Federal Defense Attorneys and Former Prosecutors – Oberheiden, P.C. is a team of federal defense attorneys and former federal prosecutors who devote their careers to federal healthcare fraud matters.
  • Our Extensive Experience in Healthcare Fraud Investigations – Our Virginia federal healthcare fraud defense attorneys have handled thousands of federal healthcare fraud audits, investigations, and prosecutions on behalf of healthcare providers in Virginia and nationwide.
  • Our Established Track Record Prior to Charges Being Filed – We have resolved the majority of our cases without clients facing federal charges.
  • Our Focus on Federal Healthcare Fraud Defense – Our practice focuses on federal healthcare fraud defense. Our Virginia federal healthcare fraud lawyers have experience representing:
    • Physicians,
    • Pharmacists,
    • Clinics,
    • Laboratories,
    • Hospitals,
    • Hospices, and
    • Virtually all other types of healthcare providers.
  • Our Proven Defense Strategies and Custom-Tailored Legal Representation – We take an aggressive approach to representing our clients allowing us to quickly and cost-effectively build defense strategies based on each client’s situation.
Virginia Healthcare Fraud

Frequently Asked Questions

What is the False Claims Act?

The False Claims Act is the main federal healthcare fraud statute in the United States. The statute bars anyone from knowingly submitting a fraudulent or false claim to a federally funded program. However, it is important to say that “knowingly” in this context refers to the submission of the claim, not an intent to defraud the government. Even an unintentional billing code mistake or pattern of minor errors can result in civil penalties. There are several defenses to alleged violations of the False Claims Act. Many involve a practitioner’s lack of knowledge of the errors. An experienced Virginia federal healthcare fraud defense attorney can help you understand the nature of the government’s allegations and how to defend against them.

What is the difference between the Anti-Kickback Statute and the Stark Law?

Both the Anti-Kickback Statute (AKS) and the Stark Law limit a provider’s ability to receive referral payments. However, the two laws are distinct in several respects. The AKS forbids providers from receiving or paying anything of value for referring a patient whose medical bills are covered under a federal program. The Stark Law applies to all patients, even those who do not receive government benefits. The Stark Law limits situations where a provider refers patients to another practice in which the referring party has a financial interest. Both statutes can result in significant civil penalties. However, only the AKS carries the potential of criminal sanctions. If you are under investigation for healthcare fraud, contact an experienced Virginia criminal defense attorney today to protect your interests.

When are physician kickbacks allowed?

In the healthcare industry, kickbacks or referral fees are common. However, some referral arrangements run afoul of federal healthcare fraud laws. The Eliminating Kickbacks in Recovery Act prohibits physicians from accepting or paying kickbacks for referrals to recovery homes, clinical treatment facilities, or labs. The Anti-Kickback Statute prohibits a physician (or anyone else) from paying or receiving anything of value for referring a patient whose medical bills are covered by a federally funded program. Lastly, the Stark Law imposes civil liability on providers who refer patients to practices in which they have a financial interest. While nothing prohibits referral arrangements in general, healthcare providers should consult with a Virginia healthcare fraud defense lawyer to ensure that an arrangement does not violate federal law.

Which federal agencies are in charge of investigating healthcare fraud?

Federal healthcare fraud laws are very complex, and this is reflected in the government’s enforcement structure. Primarily, the Federal Bureau of Investigation is responsible for investigating claims of healthcare fraud. However, the FBI often cooperated with one or more other federal agencies. Thus, if the DEA, OIG, DEA, or other federal agency is contacting you with questions about an investigation, you should assume that you are under investigation for healthcare fraud and take the necessary precautions. The most important thing to keep in mind is that anything you say to an investigator can be used against you later. Thus, it is best not to speak with any federal agent or investigator until you speak with a Virginia healthcare fraud defense attorney first. A lawyer can help you understand the nature of the investigation, what is at stake, and how to respond to investigators to minimize your risk.


Discuss Your Federal Healthcare Fraud Investigation in Confidence

Healthcare fraud is against the law and when it leads to serious bodily injury or death, penalties can include fines or sentences of 10 to 20 years in prison. If your Virginia healthcare business or practice is targeted in a federal healthcare fraud investigation, we strongly encourage you to contact our federal defense team for a confidential case assessment. To speak with a Virginia federal healthcare fraud lawyer for free, call 703-952-0247 or inquire online now.

All website terms, conditions, and disclaimers apply to this information and are hereby fully incorporated. Specifically, this information has been prepared (1) for informational purposes only and does not constitute legal advice; (2) This information may constitute attorney advertising in some jurisdictions; (3) Merely reading this information does not create an attorney-client relationship; (4) Attorneys of Oberheiden, P.C., are not licensed in all states but are only licensed to practice in the states mentioned in their respective biographies. Nothing contained in here is meant to constitute the unauthorized practice of law or a suggestion of physical presence in the state; (5) Prior results do not guarantee similar outcomes in the future.
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