West Palm Beach Healthcare Attorneys
West Palm Beach Healthcare Fraud Defense Team Lead
Former Deputy Chief, Appellate Division
700 S Rosemary Square Suite 204
West Palm Beach, FL 33401
888-680-1745
Federal law enforcement aggressively targets healthcare providers in West Palm Beach, FL. If your business or practice is under investigation, you need the experienced West Palm Beach healthcare fraud defense attorneys at Oberheiden, P.C., right away.
Agencies, including the DOJ, OIG, and DEA, make a concerted effort to rein in healthcare fraud, waste, medical malpractice, and abuse in America. Federal agents have set their sights on key cities and regions where fraud has been most rampant. Also targeted are areas where many federal beneficiaries reside. West Palm Beach is one of those areas.
We are a federal healthcare fraud defense firm representing both individual providers and business entities in West Palm Beach.
The attorneys at Oberheiden, P.C. are backed by their cumulative legal experience. Several of the West Palm Beach healthcare lawyers on our staff worked as federal prosecutors at the Department of Justice or in other federal prosecutorial roles before moving to private legal defense.
Our skilled West Palm Beach, Florida healthcare fraud defense attorneys have a reputation for sparing our clients from criminal charges with a record to back it up. Let us use our experience and insight to defend you against federal scrutiny. There’s a lot on the line, potentially including your freedom. We do everything we can to protect it. In the majority of cases, clients have maintained their practice, their license, and their reputation with no criminal charge filed..
What Is Healthcare Fraud?
What does it mean to be under investigation for healthcare fraud in West Palm Beach? That depends on a number of things, for example:
- Which agencies are involved in investigating you?
- Is your investigation currently civil or criminal in nature?
- What conduct or activity alerted federal authorities to your practice?
- What kind of services have you billed the government for?
- How long has the investigation been going on?
- If charges are being considered, are they imminent? And which statutes are alleged to have been broken?
There are many kinds of healthcare fraud under the health 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 unneeded services
- Billing for services not actually rendered to patients
-
Falsifying patient records, personal injury claims, prescriptions, physician certifications, or election statements
When a client hires our West Palm Beach healthcare attorneys, we begin by getting the facts we need. In addition to contacting the federal agencies involved, we conduct our own investigation. This helps us determine what’s going on and how we can most effectively defend you against any allegations. Below are several of the criminal statutes and other laws most commonly used in healthcare fraud cases.
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
Following are a handful of the most common statutes, laws, regulations, and directives resulting in criminal prosecutions of healthcare providers in West Palm Beach, FL.
1. The False Claims Act
The False Claims Act (FCA) prohibits submitting any “false or fraudulent” invoices or claims to the federal government. Any healthcare provider or healthcare businesses that submit a claim for payment to a program such as Tricare, Medicare, or Medicaid is subject to FCA requirements, as well as the civil and criminal penalties for violating it. The penalties of this health care law can be quite steep. They apply on a “per claim” basis, and they can also include program exclusion and/or time in federal prison.
2. The Anti-Kickback Statute
The Anti-Kickback Statute (AKS) prohibits offering, paying, soliciting, or receiving remuneration (including referral fees) in exchange for patient referrals if the patient receives federal benefits. As with the False Claims Act, the AKS provides for both civil and criminal prosecution of a healthcare provider. An AKS charge can be life-altering, and it may threaten your medical practice’s very existence.
3. The Stark Law
The Stark Law prohibits so-called “physician self-referrals,” a term that has been defined more broadly than you might expect. The Stark Law is more limited in scope than the Anti-Kickback Statute, but it results in far too many cases of doctors and medical practices charged with illegal activities. This can occur even when the facts really don’t warrant the Stark Law’s sizable civil penalties.
4. The Controlled Substances Act (CSA)
The Controlled Substances Act is the primary source of the United States’ drug policies. It is also used to prosecute healthcare providers suspected of misusing their DEA registration or otherwise engaging in pharmaceutical fraud. This includes:
- Writing unnecessary prescriptions,
- Selling prescriptions or selling medications,
- Providing certain substances to drug-dependent patients,
- Opioid diversion, and
- Other unlawful practices.
Most “pill mill” investigations in West Palm Beach pertain to the Controlled Substances Act.
5. The Federal Healthcare Fraud Statute
For federal prosecutors, 18 U.S.C. 1347 functions as a go-to charging instrument. It is written broadly and is generally referred to as simply “the healthcare fraud statute.” Its plain text makes it a federal crime 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.”
6. Other Fraud Statutes
Along with the criminal statutes described above, healthcare providers in West Palm Beach may face allegations of related charges. These include:
- Wire fraud
- Mail fraud
- Forgery
- Making false statements
- Federal conspiracy
- Wrongful use of health information
7. Program Billing Regulations
Healthcare benefits agencies such as the CMS may establish their own rules and regulations. Violating these program billing regulations may end in very serious results, even with no evidence of intent. This is unlike most healthcare fraud statutes that do require proof of intent. Care providers in West Palm Beach can lessen their risk of prosecution by maintaining a proactive compliance program.
8. DOJ Mandates
Mandates from the Department of Justice are public notices or internal memoranda about the issues DOJ agents should prioritize. Currently, healthcare fraud and opioid diversion are among the Department’s top priorities. The DOJ made the priority clear when it announced formation of two federal task forces. They are the Opioid Fraud and Abuse Detection Unit and the Prescription Interdiction & Litigation (PIL) Task Force.
5 Reasons to Trust Oberheiden, P.C. and Our West Palm Beach Federal Healthcare Fraud Defense Lawyers healthcare fraud defense lawyer:
Here are five reasons why healthcare providers and other Medicare, Medicaid, and Tricare participants in West Palm Beach should choose Oberheiden, P.C. as their healthcare fraud defense lawyer:
- Our Extensive Experience in Healthcare Fraud Investigations – Our proven West Palm Beach healthcare lawyers have handled thousands of federal healthcare fraud audits, healthcare compliance investigations, and prosecutions on behalf of healthcare providers in West Palm Beach and nationwide.
- Our Record of Avoiding Charges – In the majority of our cases, we have been able to end criminal investigations without the filing of criminal charges or business litigation.
- Our Focus on Federal Healthcare Fraud Defense – Our Focus on Federal Healthcare Fraud Defense – Healthcare fraud defense is our law firm’s principal focus. Our established West Palm Beach healthcare fraud defense lawyers have represented healthcare professionals:
- Physicians,
- Pharmacists,
- Clinics,
- Labs,
- Hospitals,
- Hospices, and
- Virtually every other category of healthcare provider.
- Our Experience on Both Sides – Several of our senior defense attorneys are also former federal prosecutors and members of the Florida Bar. We believe this “dual perspective” helps us negotiate effectively with current federal prosecutors.
- Our Aggressive Defense Strategies – Unlike other law firms, our committed West Palm Beach healthcare fraud defense lawyers take an aggressive approach to defending clients in every case. Your freedom and your financial interests may depend on it. We never lose sight of that, and it drives every second we spend representing you.
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 investigation or criminal matter.
Frequently Asked Questions
What is a qui tam lawsuit?
A qui tam lawsuit is a type of civil claim brought against a healthcare provider. However, a qui tam lawsuit is unique from other healthcare fraud claims because it begins with a whistleblower, also known as a relator. This person can be anyone with knowledge of a healthcare provider’s business including:
- Former employees,
- Current or former patients,
- Current or former business partners, or
- Any other party with evidence they believe suggests fraud.
Once a relator brings evidence to the attention of the federal government, the government is mandated to conduct a formal investigation and decide whether or not to intervene in the case. However, even if the government chooses not to intervene, the relator can proceed with the case on their own. Relators may receive up to 30 percent of the amount recovered if the case finds liability. If someone blew the whistle on you or your practice, it is important to contact a Florida federal healthcare fraud defense attorney to reduce the chances of federal involvement and a potential trial.
What are the most common examples of Medicare fraud?
Medicare fraud is an overarching term used to describe any false or fraudulent claims submitted to the Medicare program. There are many ways a provider or practice can raise the suspicion of federal investigators. Some of the most common examples of Medicare fraud include:
- Billing for services that were not performed or not medically necessary;
- Billing for supplies or equipment that were never ordered;
- Billing for supplies or equipment that were not medically necessary;
- Certification for services or supplies that were not medically necessary;
- Double billing, up-coding, and inflating medical bills; and
- Overutilization of services or equipment.
If facing allegations of federal healthcare fraud, you can be sure the investigators overseeing your case know just as much—if not more—about your business than you. You need a West Palm Beach healthcare attorney with knowledge and experience handling these complex and high-stakes claims.
Who should I talk to if I am under investigation for federal healthcare fraud?
Not knowing who the government has spoken to and what agreements they’ve made is an issue faced by those under investigation for federal healthcare fraud. This can make it difficult, not to mention dangerous, for anyone facing fraud charges to know where to turn. The last thing you want is to reach out to a business partner when they are secretly working with federal agents. If you are in the midst of a federal investigation, an experienced West Palm Beach healthcare defense lawyer is the only safe person to speak with about the case. A health care lawyer can communicate with the government on your behalf to learn more about the allegations so, together, you can craft an effective defense.
Discuss Your Federal Healthcare Fraud Investigation in Confidence
If your Palm Beach Gardens healthcare practice or company is being targeted in a federal healthcare fraud investigation, we strongly encourage you to contact our West Palm Beach office for a confidential case assessment. To speak with our West Palm Beach healthcare attorney for free, call 888-680-1745 or inquire online, right away.
- West Palm Beach federal criminal defense
- West Palm Beach white collar crime
- West Palm Beach whistleblower defense
