Bellevue Healthcare Fraud Defense Lawyers
Is your Bellevue healthcare practice or medical business facing an audit or investigation? Our federal healthcare fraud defense lawyers can use their centuries of high-level experience to protect you. To put our career defense attorneys and former federal prosecutors on your side, call 888-680-1745 or request a free case assessment online now.
Healthcare providers in Bellevue, Illinois are facing close scrutiny from federal authorities and “fee-for-service” audit contractors working with the Centers for Medicare and Medicaid Services (CMS). While federal program fraud and opioid diversion are currently top federal law enforcement priorities, all violations of the False Claims Act, Anti-Kickback Statute, Controlled Substances Act, and other statutes are likely to garner the federal government’s attention, and even unintentional violations can trigger recoupments, fines, and other penalties.
In many cases, however, healthcare providers are facing consequences that are far more severe. In cases of criminal healthcare fraud, physicians, pharmacists, and other providers in Bellevue can face years or decades of federal imprisonment. When their freedom is eventually restored, providers find themselves without a professional license, without a practice to which to return, and with a reputation that has been thoroughly and utterly destroyed.
Do Not Let an Audit or Investigation End Your Practice and Threaten Your Freedom
While these risks are very real, the outcome of a federal healthcare fraud audit or investigation is not a foregone conclusion. If you are facing an audit or investigation, you can affect the outcome. Our record proves it, and our attorneys can use their experience to help you avoid unnecessary consequences.
What is Oberheiden P.C.?
Oberheiden, P.C. is a federal defense law firm that represents healthcare providers nationwide in audits, investigations, and civil and criminal enforcement matters. With a team of highly-experienced in-house senior healthcare fraud attorneys and a nationwide network of lawyers who all have extensive experience in the area of federal defense, we provide strategic and effective representation that is guided by our results in prior cases. We have seen what works, and we know when, why, and how the U.S. Department of Justice (DOJ) decides to prosecute. If your Bellevue healthcare business or medical practice is being audited or targeted in a federal fraud investigation, we can protect you.
Why Choose Oberheiden P.C. in Bellevue?
If you are facing a MAC, RAC, UPIC, or ZPIC audit, if you have been contacted by CMS or the DOJ, or if your business or practice is being targeted by any other federal agency or task force in Bellevue, why should you choose Oberheiden P.C. for healthcare fraud defense?
1. We Provide Nationwide Federal Defense
Our healthcare fraud defense practice is nationwide in scope. This allows us to pick up on federal law enforcement trends, keep pace with the federal government’s new law enforcement initiatives, and effectively represent clients who may be accused of participating in nationwide healthcare fraud “conspiracies.” We have the attorneys and resources to handle cases that are confined to Bellevue and that cross state lines, and we know how to efficiently handle high-risk and large-scale cases without letting the federal government fully take the reins.
2. We Focus on Healthcare Fraud Defense
A significant portion of our practice is devoted to federal healthcare fraud defense. Many of our attorneys’ backgrounds are in this area (including founding attorney Dr. Nick Oberheiden), and our federal defense team includes several former DOJ attorneys who previously prosecuted healthcare fraud cases on behalf of the federal government. We understand the unique complexity of these cases, and we also understand the extreme risks involved. We use our vast knowledge of federal healthcare laws and program billing regulations to our clients’ advantage.
3. Our Team Includes Several Former Healthcare Fraud Prosecutors and Investigators
Wouldn’t it be nice to know what federal authorities are thinking? At Oberheiden P.C., we can tell you—definitively. This is because in addition to our former DOJ prosecutors, we also employ the services of several former federal agents with the Office of Inspector General (OIG), Federal Bureau of Investigation (FBI), Internal Revenue Service (IRS), and other agencies. We offer our clients decades worth of insights gained from working directly for the agencies that are accusing them of healthcare fraud.
4. Our Practice Focuses on Pre-Charge Resolution
While it is important to know that your defense lawyers are prepared to defend you at trial if necessary, it is far more important to know that your lawyers are doing everything possible to prevent your case from going to trial. At Oberheiden P.C., we emphasize pre-trial resolution. We promptly intervene in our clients’ audits and investigations, and we work diligently to convince auditors, investigators, and prosecutors that our clients’ practices do not warrant further scrutiny. If we can prevent charges from being filed, you can get back to business as usual.
5. Our Results (and Our Clients) Speak for Themselves
We have resolved the majority of our clients’ audits and investigations without civil or criminal charges being filed, and to date not a single client of Oberheiden P.C. has faced False Claims Act liability as a result of a healthcare fraud investigation in which we have been involved. Our clients also routinely provide testimonials thanking our attorneys for defending them effectively. In short, our results and our clients speak for themselves, and we are proud to let them do so.
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Call Dr. Nick Oberheiden now!888-680-1745
What are the Differences Between an Audit and an Investigation?
There are two primary ways that CMS, the DOJ, the OIG, and other federal authorities seek recoupments and other penalties in cases of alleged healthcare fraud: audits and investigations. While audits and investigations are very different, the ultimate consequences can be the same, and both require an equally strategic and custom-tailored defense.
Healthcare Fraud Audits: Contractors Get Paid to Demand Recoupments
During a healthcare fraud audit, employees of a private government contractor review the provider’s program billing records for evidence of overbillings. These contractors receive additional compensation from CMS if they uncover improper payments from federal government programs; and, as a result, accusations of overbilling are extremely common. However, in our experience, they are also frequently unjustified, and disputing unfounded audit determinations before they become final is critical to avoiding the long and time-intensive audit appeals process.
Healthcare Fraud Investigations: Fighting Healthcare Fraud is a Top Federal Priority
During a federal healthcare fraud investigation, agents from the OIG, DOJ, and various other agencies work to collect the evidence required to substantiate allegations of healthcare fraud. Federal authorities have various investigative tools at their disposal, including informal requests for “interviews,” civil investigative demands (CIDs), and federal subpoenas. Healthcare fraud investigations often involve numerous agencies (or coordinated task forces, such as the Opioid Fraud and Abuse Detection Unit), and they can lead to charges for a variety of related and unrelated offenses.
Frequently Asked Questions
What is “Healthcare Fraud”?
Of course, all of this begs the question: What exactly is “healthcare fraud”?
Allegations of federal healthcare fraud can take many different forms. While there are certain acts that are exclusively criminal in nature (i.e. taking part in a healthcare fraud “conspiracy”), many statutes include provisions for both civil and criminal enforcement. Examples of acts and practices that can be prosecuted as civil or criminal healthcare fraud include (but are not limited to):
- Fraudulently certifying medical necessity or certifying a patient for hospice or home health services
- Upcoding medical services or procedures in order to bill at a falsely-inflated rate
- Unbundling related medical services or procedures in order to bill at higher individual rates
- Billing for services not actually provided or procedures not actually performed (“phantom billing”)
- Billing Medicare, Medicaid, or another federal benefit program for non-existent patients (or “ghost patients”)
- Offering, soliciting, paying, or receiving unlawful referral fees in violation of the Anti-Kickback Statute
- Engaging in prohibited transactions relating to designated health services under the Stark Law
- Providing opioid pain medications without medical necessity or without performing a re-examination prior to refilling a prescription
Am I facing civil or criminal penalties?
In healthcare fraud audits, CMS contractors only have the authority to impose civil penalties. However, auditors have the authority (and often the obligation) to report providers to CMS and the DOJ when they uncover evidence of alleged fraud, and this can trigger a follow-on investigation. Investigations can be either civil or criminal in nature, and investigations that start out civil can transition into criminal inquiries. As a result, providers need to treat all audits and investigations with equal care, and they must engage experienced federal defense counsel in order to protect against being civilly or criminally charged with healthcare fraud.
What is a whistleblower?
A whistleblower is a person who relates information pertaining to another’s alleged healthcare fraud in hopes of obtaining a monetary reward for doing so. Whistleblower claims are brought under the qui tam provision of the False Claims Act. In most instances, a whistleblower contacts the federal government and provides prosecutors with information about the alleged fraud. Federal prosecutors then interview the whistleblower and conduct their own investigation before determining whether to intervene in the case. However, even if the federal government chooses not to get involved, the whistleblower can proceed individually on behalf of the government. Notably, whistleblower claims are often suspect due to the fact that a whistleblower can recover as much as 30 percent of the amount recovered. Anyone facing allegations of healthcare fraud—even if made by a whistleblower—should consult with a Bellevue, Illinois federal healthcare fraud defense attorney as soon as possible.
What can I do to avoid federal healthcare fraud charges?
If you are under investigation for healthcare fraud, it is imperative that you are proactive in your approach to the allegations. Although it may seem like there is little you can do to prevent the inevitable, that couldn’t be further from the truth. An experienced Bellevue federal healthcare fraud defense attorney can help in several ways. For example, in some cases, federal prosecutors will look at any remedial actions you took to bring your practices back into compliance—even after the investigation was well underway. Moreover, a Bellevue, IL federal healthcare fraud defense attorney can critically examine the government’s case to identify any weaknesses.
Is Your Bellevue Healthcare Practice or Medical Business at Risk?
Our firm is actively representing several physicians, pharmacists, clinics, laboratories, telemedicine companies, durable medical equipment (DME) companies, and other clients in federal healthcare fraud audits and investigations. If your Bellevue practice or business is being targeted, call 888-680-1745 or contact us online now for a free and confidential case assessment.