For health care providers in Indianapolis, Bloomington, South Bend, and other parts of Indiana, federal health care fraud investigations can lead to fines, program exclusion, prison time, and other penalties. To protect yourself and your business or practice, call Oberheiden, P.C. at 888-519-4897 today.
Federal authorities are targeting Indiana health care providers in civil and criminal fraud investigations. Often alleging offenses such as double-billing, improperly dispensing opioid medications, and offering or accepting illegal kickbacks or referral fees, agents and prosecutors from the Drug Enforcement Administration (DEA), Department of Justice (DOJ), Office of Inspector General (OIG), and other agencies are contacting providers with target letters, civil investigative demands, and subpoenas, and they are looking for any justification to file civil or criminal charges.
As a health care provider in Indiana, what does this mean for you? Most immediately, it means that you need to be aware of the risk of a federal investigation. You need to understand that federal agents may come knocking at your door (literally or figuratively); and, when they do, you need to be prepared to defend yourself by all means available.
Federal Defense Lawyers for Medical Practitioners, Business Owners, and Others Accused of Health Care Fraud
At Oberheiden, P.C., our attorneys are committed to defending physicians, pharmacists, clinic and laboratory owners, health care company executives, and other clients in federal health care fraud investigations. While Medicare and Medicaid fraud are undoubtedly serious issues that cost the federal government billions of dollars each year, not all allegations of Medicare and Medicaid fraud are justified. Frequently, the government’s reliance on data analysis and whistleblower allegations leads to misguided enforcement efforts, and the providers targeted in these efforts must justify their billing practices in order to avoid prosecution.
With our attorneys’ extensive experience as defense attorneys and former federal health care fraud prosecutors with the DOJ, we have amassed a substantial track record of defending providers in DEA, DOJ, and OIG investigations. We have successfully represented clients in numerous investigations involving the Federal Bureau of Investigation (FBI), Internal Revenue Service (IRS), and other agencies as well, and we have also secured numerous favorable verdicts at trial. Regardless of the current status of your case, and regardless of whether you have a clear understanding of why you are being targeted (initially, many of our clients do not), we can help, and we encourage you to contact us promptly for a free and confidential case assessment.
Are you facing a health care fraud audit or investigation in Indiana? Call 888-519-4897 now to speak with a member of our federal defense team in confidence.
Trusted Attorneys for Federal Health Care Fraud Investigations in Indiana
While every case involves unique aspects, the DEA, DOJ, FBI, IRS, and OIG commonly target health care providers with similar allegations. For example, we routinely represent clients accused of improper and illegal practices including:
1. Billing and Coding Errors
Billing and coding errors include submitting the wrong billing code, “upcoding” services and supplies, “unbundling” services and supplies, and double-billing the federal government and/or a private insurer. Alleged billing and coding errors are at the center of many health care fraud investigations, and our attorneys are intimately familiar with the rules and regulations that govern providers’ participation in Medicare, Medicaid, Tricare, and the Department of Labor’s (DOL) health care benefit program.
2. Kickbacks, Bribes, and Rebates
In certain circumstances, health care providers may unknowingly enter into commercial transactions and business relationships that facially violate the federal Anti-Kickback Statute. This statute makes it a federal offense to accept any kickback, bribe, rebate, or other form of “remuneration” in exchange for a referral for program-reimbursed services.
However, in many cases, these providers will also qualify for protection under one of the Anti-Kickback Statute’s “safe harbor” provisions. These provisions permit certain specified transactions and relationships that would otherwise violate the statute’s broad prohibitory language. We have successfully defended numerous clients in Anti-Kickback Statute investigations, in many cases by demonstrating that one of the statute’s safe harbors applies.
3. Physician Self-Referrals
Physicians and their related entities can also face investigations as a result of alleged “physician self-referrals.” These transactions are prohibited under the federal Stark Law with respect to certain “designated health services” that are reimbursable under Medicare or Medicaid. Designated health services under the Stark Law include:
- Clinical laboratory service
- Physical therapy services
- Occupational therapy services
- Outpatient speech-language pathology services
- Radiology and certain other imaging services
- Radiation therapy services and supplies
- Durable medical equipment and supplies
- Parenteral and enteral nutrients, equipment, and supplies
- Prosthetics, orthotics, and prosthetic devices and supplies
- Home health services
- Outpatient prescription drugs
- Inpatient and outpatient hospital services
4. False and Fraudulent Claims
The broadest category of health care-related offenses consists of the submission of “false and fraudulent” claims for federal program reimbursement. The False Claims Act prohibits all improper reimbursement requests, and it imposes criminal penalties for intentional billing fraud. Even providers who unintentionally overbill Medicare, Medicaid, Tricare, or the DOL can face civil penalties, including fines, recoupment, treble damages, pre-payment review, and program exclusion.
5. Billing for Medically-Unnecessary Services, Supplies, or Equipment
Billing for services, supplies, or equipment deemed not medically-necessary under the applicable program guidelines can result in investigation and prosecution under the False Claims Act and/or the federal health care fraud statute. If federal authorities are questioning the soundness of your independent medical judgment, our attorneys can use their vast experience in similar matters to help demonstrate the validity of your program billings.
6. Billing for Services, Supplies, or Equipment Not Provided
Billing for services, supplies, or equipment not provided can be prosecuted as a False Claims Act and/or health care fraud statute violation as well. While some providers may intentionally engage in such “phantom billing” practices, it is far more common for these allegations to result from administrative errors or federal authorities’ misinterpretation of providers’ patient and billing records.
7. Prescription Drug Fraud
Prescription drug fraud investigations often involve multiple federal law enforcement agencies, and they can lead to drastic consequences for prescribing physicians, pharmacy owners, and other health care providers. We have extensive experience in prescription drug fraud cases involving opioids and other medications; and, if your practice is under investigation, we can help you avoid dangerous and unnecessary consequences.
8. Falsifying Patient Records and Inaccurately Reporting Test Results
Allegations of falsifying patient records and inaccurately reporting test results are commonly the result of misguided assumptions and oversights during the investigative process as well. We can review the totality of your practice’s patient and billing records to set the record straight; and, if there are mistakes that need to be addressed, we can help you demonstrate good-faith efforts at compliance.
9. Fraudulent Physician Certifications and Election Statements
For hospices and physicians who certify patients for hospice care, allegations of forging and preparing fraudulent physician certifications and election statements can lead to severe penalties. We have successfully defended numerous hospices and physicians in these types of cases, and we can use this experience to your advantage.
10. Tax Evasion and Other Related Federal Offenses
In many cases, in addition to targeting providers with health care-specific allegations, federal agents and prosecutors will seek to charge providers with various other offenses as well. In addition to defending providers against charges of health care fraud, we also provide aggressive representation for defense of tax evasion, mail fraud, wire fraud, money laundering, conspiracy, and other related allegations.
Additional Resources for Indiana Health Care Providers Facing DEA, DOJ, FBI, IRS, and OIG Investigations
For health care providers targeted in audits and investigations, understanding the substantive and procedural issues involved in these proceedings is critical to making informed decisions. To learn more about what you need to know, we encourage you to read these articles written by our federal health care fraud defense attorneys:
- Glossary: Understanding Your Federal Health Care Fraud Investigation – Learn about some of the key terminology you will encounter during your health care fraud investigation.
- Q&A with Federal Health Care Fraud Defense Lawyer, Nick Oberheiden, PhD: What Do You Need to Know If Your Practice Is Under Investigation? – Learn what you need to know in order to protect your medical practice during an investigation from firm founder Dr. Nick Oberheiden.
- What Constitutes a “Safe Harbor” in an Anti-Kickback Statute Investigation? – Learn about some of the more-common safe harbors used to defend against allegations of civil and criminal Anti-Kickback Statute violations.
- What Kinds of Billing and Coding Errors Constitute Health Care Fraud? – Learn more about the billing and coding errors that can lead to prosecution under the False Claims Act and the federal health care fraud statute.
- What Types of Activities Are Covered Under the False Claims Act? – Learn about common allegations against health care providers under the False Claims Act and how our attorneys defend clients against them.
Schedule a Confidential Initial Case Assessment at Oberheiden, P.C.
If your Indiana health care practice or medical business is under investigation by the DEA, DOJ, FBI, IRS, OIG, or another federal agency, it is important that you seek legal representation immediately. To discuss your case with the federal defense attorneys at Oberheiden, P.C., call 888-519-4897 or request an appointment online now.